Age-dependent prognostic value of exercise capacity and derivation of fitne-aociated biologic age

Michael Blaha, Rupert K. Hung, Zeina Dardari, David I. Feldman, Seamus Whelton, Khurram Nasir, Roger S Blumenthal, Clinton A. Brawner, Jonathan K. Ehrman, Steven J. Keteyian, Mouaz H. Al-Mallah

Research output: Contribution to journalArticle

Abstract

Objective Given the aging population and prevalence of sedentary behaviour in the USA, we investigated the impact of differences in exercise capacity aociated with age on long-term outcomes. We derived fitneaociated 'biologic age' as a tool to encourage positive lifestyle changes. Methods This retrospective cohort study included 57 085 patients without established coronary artery disease or heart failure (median age 53 years, 49% women, 29% black) who underwent clinically-referred treadmill stre testing at the Henry Ford Health System from 1991 to 2009. Patients were followed for 10.4±5 and 5.4±4 years for all-cause mortality and myocardial infarction (MI), respectively. We calculated hazard ratios aociated with exercise capacity by age deciles using Cox regreion models, adjusting for demographic and haemodynamic data, medical history, and medication use. Fitne-aociated 'biologic age' was derived as the chronologic age with equivalent mortality or MI risk. Results There were 6356 deaths and 1646 MIs during follow-up. Exercise capacity declined with increasing age. Higher exercise capacity was strongly aociated with greater survival, with per-MET HR ranging from 0.82 (95% CI 0.78 to 0.86) in patients under 40 years of age, to 0.88 (95% CI 0.87 to 0.90) in those over 70 years of age. Biologic age varied markedly-up to three decades-within each age decile, and was a stronger predictor of mortality (C-statistic 0.81 vs 0.77) and MI (C-statistic 0.72 vs 0.68) than chronologic age. Conclusions Higher exercise capacity remained a powerful predictor of survival despite lower average exercise capacity at older ages, reinforcing its importance in patients of all ages. Fitne-aociated biologic age was a stronger predictor of survival than chronologic age, and may be a useful clinical tool for facilitating patient discuions regarding the impact of exercise capacity on long-term risk.

Original languageEnglish (US)
Pages (from-to)431-437
Number of pages7
JournalHeart
Volume102
Issue number6
DOIs
StatePublished - Mar 1 2016

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Exercise
Myocardial Infarction
Survival
Mortality
Proportional Hazards Models
Life Style
Coronary Artery Disease
Cohort Studies
Heart Failure
Retrospective Studies
Hemodynamics
Demography
Health
Population

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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Age-dependent prognostic value of exercise capacity and derivation of fitne-aociated biologic age. / Blaha, Michael; Hung, Rupert K.; Dardari, Zeina; Feldman, David I.; Whelton, Seamus; Nasir, Khurram; Blumenthal, Roger S; Brawner, Clinton A.; Ehrman, Jonathan K.; Keteyian, Steven J.; Al-Mallah, Mouaz H.

In: Heart, Vol. 102, No. 6, 01.03.2016, p. 431-437.

Research output: Contribution to journalArticle

Blaha, M, Hung, RK, Dardari, Z, Feldman, DI, Whelton, S, Nasir, K, Blumenthal, RS, Brawner, CA, Ehrman, JK, Keteyian, SJ & Al-Mallah, MH 2016, 'Age-dependent prognostic value of exercise capacity and derivation of fitne-aociated biologic age', Heart, vol. 102, no. 6, pp. 431-437. https://doi.org/10.1136/heartjnl-2015-308537
Blaha, Michael ; Hung, Rupert K. ; Dardari, Zeina ; Feldman, David I. ; Whelton, Seamus ; Nasir, Khurram ; Blumenthal, Roger S ; Brawner, Clinton A. ; Ehrman, Jonathan K. ; Keteyian, Steven J. ; Al-Mallah, Mouaz H. / Age-dependent prognostic value of exercise capacity and derivation of fitne-aociated biologic age. In: Heart. 2016 ; Vol. 102, No. 6. pp. 431-437.
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abstract = "Objective Given the aging population and prevalence of sedentary behaviour in the USA, we investigated the impact of differences in exercise capacity aociated with age on long-term outcomes. We derived fitneaociated 'biologic age' as a tool to encourage positive lifestyle changes. Methods This retrospective cohort study included 57 085 patients without established coronary artery disease or heart failure (median age 53 years, 49{\%} women, 29{\%} black) who underwent clinically-referred treadmill stre testing at the Henry Ford Health System from 1991 to 2009. Patients were followed for 10.4±5 and 5.4±4 years for all-cause mortality and myocardial infarction (MI), respectively. We calculated hazard ratios aociated with exercise capacity by age deciles using Cox regreion models, adjusting for demographic and haemodynamic data, medical history, and medication use. Fitne-aociated 'biologic age' was derived as the chronologic age with equivalent mortality or MI risk. Results There were 6356 deaths and 1646 MIs during follow-up. Exercise capacity declined with increasing age. Higher exercise capacity was strongly aociated with greater survival, with per-MET HR ranging from 0.82 (95{\%} CI 0.78 to 0.86) in patients under 40 years of age, to 0.88 (95{\%} CI 0.87 to 0.90) in those over 70 years of age. Biologic age varied markedly-up to three decades-within each age decile, and was a stronger predictor of mortality (C-statistic 0.81 vs 0.77) and MI (C-statistic 0.72 vs 0.68) than chronologic age. Conclusions Higher exercise capacity remained a powerful predictor of survival despite lower average exercise capacity at older ages, reinforcing its importance in patients of all ages. Fitne-aociated biologic age was a stronger predictor of survival than chronologic age, and may be a useful clinical tool for facilitating patient discuions regarding the impact of exercise capacity on long-term risk.",
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T1 - Age-dependent prognostic value of exercise capacity and derivation of fitne-aociated biologic age

AU - Blaha, Michael

AU - Hung, Rupert K.

AU - Dardari, Zeina

AU - Feldman, David I.

AU - Whelton, Seamus

AU - Nasir, Khurram

AU - Blumenthal, Roger S

AU - Brawner, Clinton A.

AU - Ehrman, Jonathan K.

AU - Keteyian, Steven J.

AU - Al-Mallah, Mouaz H.

PY - 2016/3/1

Y1 - 2016/3/1

N2 - Objective Given the aging population and prevalence of sedentary behaviour in the USA, we investigated the impact of differences in exercise capacity aociated with age on long-term outcomes. We derived fitneaociated 'biologic age' as a tool to encourage positive lifestyle changes. Methods This retrospective cohort study included 57 085 patients without established coronary artery disease or heart failure (median age 53 years, 49% women, 29% black) who underwent clinically-referred treadmill stre testing at the Henry Ford Health System from 1991 to 2009. Patients were followed for 10.4±5 and 5.4±4 years for all-cause mortality and myocardial infarction (MI), respectively. We calculated hazard ratios aociated with exercise capacity by age deciles using Cox regreion models, adjusting for demographic and haemodynamic data, medical history, and medication use. Fitne-aociated 'biologic age' was derived as the chronologic age with equivalent mortality or MI risk. Results There were 6356 deaths and 1646 MIs during follow-up. Exercise capacity declined with increasing age. Higher exercise capacity was strongly aociated with greater survival, with per-MET HR ranging from 0.82 (95% CI 0.78 to 0.86) in patients under 40 years of age, to 0.88 (95% CI 0.87 to 0.90) in those over 70 years of age. Biologic age varied markedly-up to three decades-within each age decile, and was a stronger predictor of mortality (C-statistic 0.81 vs 0.77) and MI (C-statistic 0.72 vs 0.68) than chronologic age. Conclusions Higher exercise capacity remained a powerful predictor of survival despite lower average exercise capacity at older ages, reinforcing its importance in patients of all ages. Fitne-aociated biologic age was a stronger predictor of survival than chronologic age, and may be a useful clinical tool for facilitating patient discuions regarding the impact of exercise capacity on long-term risk.

AB - Objective Given the aging population and prevalence of sedentary behaviour in the USA, we investigated the impact of differences in exercise capacity aociated with age on long-term outcomes. We derived fitneaociated 'biologic age' as a tool to encourage positive lifestyle changes. Methods This retrospective cohort study included 57 085 patients without established coronary artery disease or heart failure (median age 53 years, 49% women, 29% black) who underwent clinically-referred treadmill stre testing at the Henry Ford Health System from 1991 to 2009. Patients were followed for 10.4±5 and 5.4±4 years for all-cause mortality and myocardial infarction (MI), respectively. We calculated hazard ratios aociated with exercise capacity by age deciles using Cox regreion models, adjusting for demographic and haemodynamic data, medical history, and medication use. Fitne-aociated 'biologic age' was derived as the chronologic age with equivalent mortality or MI risk. Results There were 6356 deaths and 1646 MIs during follow-up. Exercise capacity declined with increasing age. Higher exercise capacity was strongly aociated with greater survival, with per-MET HR ranging from 0.82 (95% CI 0.78 to 0.86) in patients under 40 years of age, to 0.88 (95% CI 0.87 to 0.90) in those over 70 years of age. Biologic age varied markedly-up to three decades-within each age decile, and was a stronger predictor of mortality (C-statistic 0.81 vs 0.77) and MI (C-statistic 0.72 vs 0.68) than chronologic age. Conclusions Higher exercise capacity remained a powerful predictor of survival despite lower average exercise capacity at older ages, reinforcing its importance in patients of all ages. Fitne-aociated biologic age was a stronger predictor of survival than chronologic age, and may be a useful clinical tool for facilitating patient discuions regarding the impact of exercise capacity on long-term risk.

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