Cardiorespiratory fitness attenuates risk for major adverse cardiac events in hyperlipidemic men and women independent of statin therapy: The Henry Ford ExercIse Testing Project

Rupert Hung, Mouaz H. Al-Mallah, Mohamud A. Qadi, Gabriel E. Shaya, Roger S Blumenthal, Khurram Nasir, Clinton A. Brawner, Steven J. Keteyian, Michael Blaha

Research output: Contribution to journalArticle

Abstract

Aims We sought to evaluate the effect of cardiorespiratory fitness (CRF) in predicting mortality, myocardial infarction (MI), and revascularization in patients with hyperlipidemia after stratification by gender and statin therapy. Methods and results This retrospective cohort study included 33,204 patients with hyperlipidemia (57 ± 12 years old, 56% men, 25% black) who underwent physician-referred treadmill stress testing at the Henry Ford Health System from 1991 to 2009. Patients were stratified by gender, baseline statin therapy, and estimated metabolic equivalents from stress testing. We computed hazard ratios using Cox regression models after adjusting for demographics, cardiac risk factors, comorbidities, pertinent medications, interaction terms, and indication for stress testing. Results There were 4,851 deaths, 1,962 MIs, and 2,686 revascularizations over a median follow-up of 10.3 years. In men and women not on statin therapy and men and women on statin therapy, each 1-metabolic equivalent increment in CRF was associated with hazard ratios of 0.86 (95% CI 0.85-0.88), 0.83 (95% CI 0.81-0.85), 0.85 (95% CI 0.83-0.87), and 0.84 (95% CI 0.81-0.87) for mortality; 0.93 (95% CI 0.90-0.96), 0.87 (95% CI 0.83-0.91), 0.89 (95% CI 0.86-0.92), and 0.90 (95% CI 0.86-0.95) for MI; and 0.91 (95% CI 0.88-0.93), 0.87 (95% CI 0.83-0.91), 0.89 (95% CI 0.87-0.92), and 0.90 (95% CI 0.86-0.94) for revascularization, respectively. No significant interactions were observed between CRF and statin therapy (P >.23). Conclusion Higher CRF attenuated risk for mortality, MI, and revascularization independent of gender and statin therapy in patients with hyperlipidemia. These results reinforce the prognostic value of CRF and support greater promotion of CRF in this patient population.

Original languageEnglish (US)
Pages (from-to)390-399.e6
JournalAmerican Heart Journal
Volume170
Issue number2
DOIs
StatePublished - Aug 1 2015

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Hydroxymethylglutaryl-CoA Reductase Inhibitors
Exercise
Hyperlipidemias
Metabolic Equivalent
Myocardial Revascularization
Myocardial Infarction
Mortality
Therapeutics
Proportional Hazards Models
Cardiorespiratory Fitness
Comorbidity
Cohort Studies
Retrospective Studies
Demography
Physicians
Health
Population

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

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Cardiorespiratory fitness attenuates risk for major adverse cardiac events in hyperlipidemic men and women independent of statin therapy : The Henry Ford ExercIse Testing Project. / Hung, Rupert; Al-Mallah, Mouaz H.; Qadi, Mohamud A.; Shaya, Gabriel E.; Blumenthal, Roger S; Nasir, Khurram; Brawner, Clinton A.; Keteyian, Steven J.; Blaha, Michael.

In: American Heart Journal, Vol. 170, No. 2, 01.08.2015, p. 390-399.e6.

Research output: Contribution to journalArticle

Hung, Rupert ; Al-Mallah, Mouaz H. ; Qadi, Mohamud A. ; Shaya, Gabriel E. ; Blumenthal, Roger S ; Nasir, Khurram ; Brawner, Clinton A. ; Keteyian, Steven J. ; Blaha, Michael. / Cardiorespiratory fitness attenuates risk for major adverse cardiac events in hyperlipidemic men and women independent of statin therapy : The Henry Ford ExercIse Testing Project. In: American Heart Journal. 2015 ; Vol. 170, No. 2. pp. 390-399.e6.
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title = "Cardiorespiratory fitness attenuates risk for major adverse cardiac events in hyperlipidemic men and women independent of statin therapy: The Henry Ford ExercIse Testing Project",
abstract = "Aims We sought to evaluate the effect of cardiorespiratory fitness (CRF) in predicting mortality, myocardial infarction (MI), and revascularization in patients with hyperlipidemia after stratification by gender and statin therapy. Methods and results This retrospective cohort study included 33,204 patients with hyperlipidemia (57 ± 12 years old, 56{\%} men, 25{\%} black) who underwent physician-referred treadmill stress testing at the Henry Ford Health System from 1991 to 2009. Patients were stratified by gender, baseline statin therapy, and estimated metabolic equivalents from stress testing. We computed hazard ratios using Cox regression models after adjusting for demographics, cardiac risk factors, comorbidities, pertinent medications, interaction terms, and indication for stress testing. Results There were 4,851 deaths, 1,962 MIs, and 2,686 revascularizations over a median follow-up of 10.3 years. In men and women not on statin therapy and men and women on statin therapy, each 1-metabolic equivalent increment in CRF was associated with hazard ratios of 0.86 (95{\%} CI 0.85-0.88), 0.83 (95{\%} CI 0.81-0.85), 0.85 (95{\%} CI 0.83-0.87), and 0.84 (95{\%} CI 0.81-0.87) for mortality; 0.93 (95{\%} CI 0.90-0.96), 0.87 (95{\%} CI 0.83-0.91), 0.89 (95{\%} CI 0.86-0.92), and 0.90 (95{\%} CI 0.86-0.95) for MI; and 0.91 (95{\%} CI 0.88-0.93), 0.87 (95{\%} CI 0.83-0.91), 0.89 (95{\%} CI 0.87-0.92), and 0.90 (95{\%} CI 0.86-0.94) for revascularization, respectively. No significant interactions were observed between CRF and statin therapy (P >.23). Conclusion Higher CRF attenuated risk for mortality, MI, and revascularization independent of gender and statin therapy in patients with hyperlipidemia. These results reinforce the prognostic value of CRF and support greater promotion of CRF in this patient population.",
author = "Rupert Hung and Al-Mallah, {Mouaz H.} and Qadi, {Mohamud A.} and Shaya, {Gabriel E.} and Blumenthal, {Roger S} and Khurram Nasir and Brawner, {Clinton A.} and Keteyian, {Steven J.} and Michael Blaha",
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T1 - Cardiorespiratory fitness attenuates risk for major adverse cardiac events in hyperlipidemic men and women independent of statin therapy

T2 - The Henry Ford ExercIse Testing Project

AU - Hung, Rupert

AU - Al-Mallah, Mouaz H.

AU - Qadi, Mohamud A.

AU - Shaya, Gabriel E.

AU - Blumenthal, Roger S

AU - Nasir, Khurram

AU - Brawner, Clinton A.

AU - Keteyian, Steven J.

AU - Blaha, Michael

PY - 2015/8/1

Y1 - 2015/8/1

N2 - Aims We sought to evaluate the effect of cardiorespiratory fitness (CRF) in predicting mortality, myocardial infarction (MI), and revascularization in patients with hyperlipidemia after stratification by gender and statin therapy. Methods and results This retrospective cohort study included 33,204 patients with hyperlipidemia (57 ± 12 years old, 56% men, 25% black) who underwent physician-referred treadmill stress testing at the Henry Ford Health System from 1991 to 2009. Patients were stratified by gender, baseline statin therapy, and estimated metabolic equivalents from stress testing. We computed hazard ratios using Cox regression models after adjusting for demographics, cardiac risk factors, comorbidities, pertinent medications, interaction terms, and indication for stress testing. Results There were 4,851 deaths, 1,962 MIs, and 2,686 revascularizations over a median follow-up of 10.3 years. In men and women not on statin therapy and men and women on statin therapy, each 1-metabolic equivalent increment in CRF was associated with hazard ratios of 0.86 (95% CI 0.85-0.88), 0.83 (95% CI 0.81-0.85), 0.85 (95% CI 0.83-0.87), and 0.84 (95% CI 0.81-0.87) for mortality; 0.93 (95% CI 0.90-0.96), 0.87 (95% CI 0.83-0.91), 0.89 (95% CI 0.86-0.92), and 0.90 (95% CI 0.86-0.95) for MI; and 0.91 (95% CI 0.88-0.93), 0.87 (95% CI 0.83-0.91), 0.89 (95% CI 0.87-0.92), and 0.90 (95% CI 0.86-0.94) for revascularization, respectively. No significant interactions were observed between CRF and statin therapy (P >.23). Conclusion Higher CRF attenuated risk for mortality, MI, and revascularization independent of gender and statin therapy in patients with hyperlipidemia. These results reinforce the prognostic value of CRF and support greater promotion of CRF in this patient population.

AB - Aims We sought to evaluate the effect of cardiorespiratory fitness (CRF) in predicting mortality, myocardial infarction (MI), and revascularization in patients with hyperlipidemia after stratification by gender and statin therapy. Methods and results This retrospective cohort study included 33,204 patients with hyperlipidemia (57 ± 12 years old, 56% men, 25% black) who underwent physician-referred treadmill stress testing at the Henry Ford Health System from 1991 to 2009. Patients were stratified by gender, baseline statin therapy, and estimated metabolic equivalents from stress testing. We computed hazard ratios using Cox regression models after adjusting for demographics, cardiac risk factors, comorbidities, pertinent medications, interaction terms, and indication for stress testing. Results There were 4,851 deaths, 1,962 MIs, and 2,686 revascularizations over a median follow-up of 10.3 years. In men and women not on statin therapy and men and women on statin therapy, each 1-metabolic equivalent increment in CRF was associated with hazard ratios of 0.86 (95% CI 0.85-0.88), 0.83 (95% CI 0.81-0.85), 0.85 (95% CI 0.83-0.87), and 0.84 (95% CI 0.81-0.87) for mortality; 0.93 (95% CI 0.90-0.96), 0.87 (95% CI 0.83-0.91), 0.89 (95% CI 0.86-0.92), and 0.90 (95% CI 0.86-0.95) for MI; and 0.91 (95% CI 0.88-0.93), 0.87 (95% CI 0.83-0.91), 0.89 (95% CI 0.87-0.92), and 0.90 (95% CI 0.86-0.94) for revascularization, respectively. No significant interactions were observed between CRF and statin therapy (P >.23). Conclusion Higher CRF attenuated risk for mortality, MI, and revascularization independent of gender and statin therapy in patients with hyperlipidemia. These results reinforce the prognostic value of CRF and support greater promotion of CRF in this patient population.

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