Circulation. 2003;108:1554-1559
Published online before print September 15, 2003, doi: 10.1161/01.CIR.0000091080.57509.E9
Published online before print September 15, 2003, doi: 10.1161/01.CIR.0000091080.57509.E9
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(Circulation. 2003;108:1554.)
© 2003 American Heart Association, Inc.
Clinical Investigation and Reports |
Exercise Capacity and the Risk of Death in Women
The St James Women Take Heart Project
From the Department of Preventive Medicine (M.G., D.K.P., H.R.B.) and Department of Medicine (M.G.), Rush-Presbyterian-St Luke’s Medical Center, Chicago, Ill; Division of Cardiology (M.F.A.) and Department of Health Studies (D.S.L., R.A.T.), University of Chicago, Chicago, Ill; and Division of Cardiology (R.H.W., A.J.A-H.), St James Hospital, Chicago Heights, Ill.
Correspondence to Martha Gulati, MD, Rush Heart Institute, Rush-Presbyterian-St Luke’s Medical Center, 1725 West Harrison Ave, Suite 020, Chicago, IL 60612. E-mail Martha_Gulati{at}rush.edu
Received May 6, 2003; revision received July 15, 2003; accepted July 15, 2003.
Background— Cardiovascular disease is the leading cause of death among women and accounts for more than half of their deaths. Women have been underrepresented in most studies of cardiovascular disease. Reduced physical fitness has been shown to increase the risk of death in men. Exercise capacity measured by exercise stress test is an objective measure of physical fitness. The hypothesis that reduced exercise capacity is associated with an increased risk of death was investigated in a cohort of 5721 asymptomatic women who underwent baseline examinations in 1992.
Methods and Results— Information collected at baseline included medical and family history, demographic characteristics, physical examination, and symptom-limited stress ECG, using the Bruce protocol. Exercise capacity was measured in metabolic equivalents (MET). Nonfasting blood was analyzed at baseline. A National Death Index search was performed to identify all-cause death and date of death up to the end of 2000. The mean age of participants at baseline was 52±11 years. Framingham Risk Score–adjusted hazards ratios (with 95% CI) of death associated with MET levels of <5, 5 to 8, and >8 were 3.1 (2.0 to 4.7), 1.9 (1.3 to 2.9), and 1.00, respectively. The Framingham Risk Score–adjusted mortality risk decreased by 17% for every 1-MET increase.
Conclusions— This is the largest cohort of asymptomatic women studied in this context over the longest period of follow-up. This study confirms that exercise capacity is an independent predictor of death in asymptomatic women, greater than what has been previously established among men. The implications for clinical practice and health care policy are far reaching.
Key Words: exercise • epidemiology • mortality • women
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
S. Mora, R. F. Redberg, A. R. Sharrett, and R. S. Blumenthal Enhanced Risk Assessment in Asymptomatic Individuals With Exercise Testing and Framingham Risk Scores Circulation, September 13, 2005; 112(11): 1566 - 1572. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
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|
|
|
|
|
|
M. Lauer, E. S. Froelicher, M. Williams, and P. Kligfield Exercise Testing in Asymptomatic Adults: A Statement for Professionals From the American Heart Association Council on Clinical Cardiology, Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention Circulation, August 2, 2005; 112(5): 771 - 776. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 O. J. Kemi, P. M. Haram, J. P. Loennechen, J.-B. Osnes, T. Skomedal, U. Wisloff, and O. Ellingsen Moderate vs. high exercise intensity: Differential effects on aerobic fitness, cardiomyocyte contractility, and endothelial function Cardiovasc Res, July 1, 2005; 67(1): 161 - 172. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. H. Mieres, L. J. Shaw, A. Arai, M. J. Budoff, S. D. Flamm, W. G. Hundley, T. H. Marwick, L. Mosca, A. R. Patel, M. A. Quinones, et al. Role of Noninvasive Testing in the Clinical Evaluation of Women With Suspected Coronary Artery Disease: Consensus Statement From the Cardiac Imaging Committee, Council on Clinical Cardiology, and the Cardiovascular Imaging and Intervention Committee, Council on Cardiovascular Radiology and Intervention, American Heart Association Circulation, February 8, 2005; 111(5): 682 - 696. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. O. Bonow Update in Cardiology Ann Intern Med, October 19, 2004; 141(8): 628 - 634. [Full Text] [PDF]
|
|
|
|
|
|
G. J. Balady, M. G. Larson, R. S. Vasan, E. P. Leip, C. J. O'Donnell, and D. Levy Usefulness of Exercise Testing in the Prediction of Coronary Disease Risk Among Asymptomatic Persons as a Function of the Framingham Risk Score Circulation, October 5, 2004; 110(14): 1920 - 1925. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. K. Aktas, V. Ozduran, C. E. Pothier, R. Lang, and M. S. Lauer Global Risk Scores and Exercise Testing for Predicting All-Cause Mortality in a Preventive Medicine Program JAMA, September 22, 2004; 292(12): 1462 - 1468. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. R. Wessel, C. B. Arant, M. B. Olson, B. D. Johnson, S. E. Reis, B. L. Sharaf, L. J. Shaw, E. Handberg, G. Sopko, S. F. Kelsey, et al. Relationship of Physical Fitness vs Body Mass Index With Coronary Artery Disease and Cardiovascular Events in Women JAMA, September 8, 2004; 292(10): 1179 - 1187. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. A. Laukkanen, S. Kurl, R. Salonen, R. Rauramaa, and J. T. Salonen The predictive value of cardiorespiratory fitness for cardiovascular events in men with various risk profiles: a prospective population-based cohort study Eur. Heart J., August 2, 2004; 25(16): 1428 - 1437. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
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|
|
|
|
|
|
A. Fowler-Brown, M. Pignone, M. Pletcher, J. A. Tice, S. F. Sutton, and K. N. Lohr Exercise Tolerance Testing To Screen for Coronary Heart Disease: A Systematic Review for the Technical Support for the U.S. Preventive Services Task Force Ann Intern Med, April 6, 2004; 140(7): W-9 - W-24. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. R. Carnethon, S. S. Gidding, R. Nehgme, S. Sidney, D. R. Jacobs Jr, and K. Liu Cardiorespiratory Fitness in Young Adulthood and the Development of Cardiovascular Disease Risk Factors JAMA, December 17, 2003; 290(23): 3092 - 3100. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Exercise Testing Results Predict Mortality in Women Journal Watch Women's Health, December 9, 2003; 2003(1209): 4 - 4. [Full Text]
|
|
|
|
|
|
D. B. Mark and M. S. Lauer Exercise Capacity: The Prognostic Variable That Doesn't Get Enough Respect Circulation, September 30, 2003; 108(13): 1534 - 1536. [Full Text] [PDF]
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|
|
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