Background Exercise capacity is known to be an important prognosticfactor in patients with cardiovascular disease, but it is uncertainwhether it predicts mortality equally well among healthy persons.There is also uncertainty regarding the predictive power ofexercise capacity relative to other clinical and exercise-testvariables.
Methods We studied a total of 6213 consecutive men referredfor treadmill exercise testing for clinical reasons during amean (±SD) of 6.2±3.7 years of follow-up. Subjectswere classified into two groups: 3679 had an abnormal exercise-testresult or a history of cardiovascular disease, or both, and2534 had a normal exercise-test result and no history of cardiovasculardisease. Overall mortality was the end point.
Results There were a total of 1256 deaths during the follow-upperiod, resulting in an average annual mortality of 2.6 percent.Men who died were older than those who survived and had a lowermaximal heart rate, lower maximal systolic and diastolic bloodpressure, and lower exercise capacity. After adjustment forage, the peak exercise capacity measured in metabolic equivalents(MET) was the strongest predictor of the risk of death amongboth normal subjects and those with cardiovascular disease.Absolute peak exercise capacity was a stronger predictor ofthe risk of death than the percentage of the age-predicted valueachieved, and there was no interaction between the use or nonuseof beta-blockade and the predictive power of exercise capacity.Each 1-MET increase in exercise capacity conferred a 12 percent improvement in survival.
From the Division of Cardiovascular Medicine, Stanford University Medical Center and the Veterans Affairs Palo Alto Health Care System — both in Palo Alto, Calif.
Address reprint requests to Dr. Myers at the Cardiology Division (111C), Veterans Affairs Palo Alto Health Care System, 3081 Miranda Ave., Palo Alto, CA 94304, or at drj993{at}aol.com.
Exercise Capacity and Mortality
Palatini P., Ko D. T., Hebert P. R., Krumholz H. M., Perlo D. H., Myers J., Froelicher V., Balady G. J.
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N Engl J Med 2002;
347:288-290, Jul 25, 2002.
Correspondence
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