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Exercise test predicts CVD mortality risk

Performance on a simple exercise test predicts the risk of death from cardiovascular disease, cancer, and other causes, reports a large study presented at EuroEcho-Imaging 2018. Good performance on the test equates to climbing three floors of stairs very fast, or four floors fast, without stopping. The findings underline the importance of fitness for longevity.

The study included 12,615 participants with known or suspected coronary artery disease. Participants underwent treadmill exercise echocardiography, in which they were asked to walk or run, gradually increasing the intensity, and continue until exhaustion. The test also generates images of the heart to check its function.

During a median 4.7-year follow-up, there were 1,253 cardiovascular deaths, 670 cancer deaths, and 650 deaths from other causes. After adjusting for age, sex, and other factors that could potentially influence the relationship, each MET (metabolic equivalent)* achieved was independently associated with 9%, 9%, and 4% lower risks of cardiovascular death, cancer death, and other causes of death during follow-up.

The death rate from cardiovascular disease was nearly three times higher in participants with poor compared to good functional capacity (3.2% versus 1.2%, p<0.001). Non-cardiovascular and non-cancer deaths were also nearly three-fold higher in those with poor compared to good functional capacity (1.7% versus 0.6%, p<0.001). Cancer deaths were almost double in participants with poor compared to good functional capacity (1.5% versus 0.8%, p<0.001).

As expected, the imaging part of the examination was predictive of cardiovascular death, but not of deaths caused by cancer or other conditions.

Study author Dr Jesús Peteiro, a cardiologist at University Hospital A Coruña, A Coruña, Spain, said: "Our results provide further evidence of the benefits of exercise and being fit on health and longevity. In addition to keeping body weight down, physical activity has positive effects on blood pressure and lipids, reduces inflammation, and improves the body's immune response to tumours."

Peteiro said people do not need to undergo exercise echocardiography to check their fitness level. "There are much cheaper ways to estimate if you could achieve ten METs on the treadmill test," he said. "If you can walk very fast up three floors of stairs without stopping, or fast up four floors without stopping, you have good functional capacity. If not, it's a good indication that you need more exercise."

ESC guidelines recommend at least 150 minutes a week of moderate aerobic physical activity or 75 minutes a week of vigorous aerobic physical activity, or a combination of the two intensities.

Abstract
Objectives: Exercise echocardiography (ExE) can predict overall and cardiovascular mortality. We aimed to assess the value of ExE for the prediction of cardiovascular (CV), cancer (CA) and non-cardiovascular non-cancer (NCV-NCA) death.
Methods: Retrospective analysis of prospectively collected data on 12,615 patients (age 62±12 years, 63% men) with a first treadmill ExE performed in our center for known/suspected coronary artery disease. Exclusion criteria were significant valve disease, cardiomyopathy, congenital heart disease, and age <18 year-old. Ischemia was defined as the development of new wall motion abnormalities (WMAs) with exercise; abnormal ExE as ischemia or resting WMAs. A good functional capacity was defined as a maximal workload of 10 metabolic equivalents (METs). The end point was death (CV, CA or NCV-NCA).
Results: During a follow-up of 4.7± 4.8 years (interquartil range 0.1-8.0 years) there were 1,253 CV, 670 CA, and 650 NCV-NCA deaths. Multivariate analysis included clinical characteristics, resting echocardiography, exercise testing and peak exercise echocardiography. Different clinical characteristics predicted CV death, along with maximal achieved workload in Metabolic Equivalents (METs: Hazard Ratio [HR]=0.91, 95% Confidence Interval [CI]=0.89-0.93, p<0.001) and ExE variables. CA death was independently predicted by clinical characteristics (age, gender, smoking, atrial fibrillation) as well as for the achieved METs (HR=0.91, 95% CI =0.88-0.93, p<0.001). Similarly NCV-NCA death was predicted by clinical characteristics (age, gender, diabetes mellitus, diuretics) and also by the achieved METs (HR=0.96, 95% CI= 0.94-0.98, p<0.001). Nor ischemia nor abnormal ExE increased the risk for CA or NCV-NCA death. Annualized CV deaths were triple in patients with bad functional capacity as compared to those with good functional capacity (3.2% vs. 1.2%, p<0.001). The same occurred for NCV-NCA death (1.7% vs. 0.6%, p<0.001), whereas CA deaths were double in patients with bad functional capacity (1.5% vs. 0.8%, p<0.001)
Conclusion: The "exercise part" of an ExE study predicts not only CV death, but death due to CA or to NCV-NCA. Fitness patients based on the achievement of 10 METs during exercise testing, have less chance of death for any cause.

Authors
JC Peteiro Vazquez, A Bouzas-Mosquera, C Barbeito-Caamano, F Broullon, JM Vazquez-Rodriguez

[link url="https://www.escardio.org/The-ESC/Press-Office/Press-releases/Performance-on-exercise-test-predicts-risk-of-death-from-cardiovascular-disease-and-cancer"]European Society of Cardiology material[/link]
[link url="https://esc365.escardio.org/Congress/EuroEcho-Imaging-2018/Poster-session-3-Stress-Echocardiography/182347-prediction-of-cardiovascular-cancer-and-noncardiovascular-noncancer-death-by-exercise-echocardiography"]ESC 365 abstract[/link]

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