Females Display Lower Risk of Myocardial Infarction From Higher Estimated Cardiorespiratory Fitness Than Males: The Tromsø Study 1994-2014

Edvard H. Sagelv PhD , Andrea Casolo PhD , Anne Elise Eggen PhD , Kim Arne Heitmann PhD , Kristoffer R. Johansen MSc , Maja-Lisa Løchen PhD , Ellisiv B. Mathiesen PhD , Bente Morseth PhD , Inger Njølstad PhD , John O. Osborne PhD , Karianne Hagerupsen MSc , Sigurd Pedersen PhD , Tom Wilsgaard PhD
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Abstract

Objective

To examine the dose-response association between estimated cardiorespiratory fitness (eCRF) and risk of myocardial infarction (MI).

Patients and Methods

Adults who attended Tromsø Study surveys 4-6 (Janurary 1,1994-December 20, 2008) with no previous cardiovascular disease were followed up through December 31, 2014 for incident MI. Associations were examined using restricted cubic splines Fine and Gray regressions, adjusted for education, smoking, alcohol, diet, sex, adiposity, physical activity, study survey, and age (timescale) in the total cohort and subsamples with hyperlipidemia (n=2956), hypertension (n=8290), obesity (n=5784), metabolic syndrome (n=1410), smokers (n=3823), and poor diet (n=3463) and in those who were physically inactive (n=6255).

Results

Of 14,285 participants (mean age ± SD, 53.7±11.4 years), 979 (6.9%) experienced MI during follow-up (median, 7.2 years; 25th-75th, 5.3-14.6 years). Females with median eCRF (32 mL/kg/min) had 43% lower MI risk (subdistributed hazard ratio [SHR], 0.57; 95% CI, 0.48-0.68) than those at the 10th percentile (25 mL/kg/min) as reference. The lowest MI risk was observed at 47 mL/kg/min (SHR, 0.02; 95% CI, 0.01-0.11). Males had 26% lower MI risk at median eCRF (40 mL/kg/min; SHR, 0.74; 95% CI, 0.63-0.86) than those at the 10th percentile (32 mL/kg/min), and the lowest risk was 69% (SHR, 0.31; 95% CI, 0.14-0.71) at 60 mL/kg/min. The associations were similar in subsamples with cardiovascular disease risk factors.

Conclusion

Higher eCRF associated with lower MI risk in females and males, but associations were more pronounced among females than those in males. This suggest eCRF as a vital estimate to implement in medical care to identify individuals at high risk of future MI, especially for females.

女性的心肺功能估计值高于男性,因而心肌梗死风险较低:1994-2014 年特罗姆瑟研究
患者和方法对参加特罗姆瑟研究调查 4-6 期(1994 年 1 月 1 日至 2008 年 12 月 20 日)、既往未患心血管疾病的成人进行随访,直至 2014 年 12 月 31 日,以了解其是否发生心肌梗死。使用限制性三次样条Fine和Gray回归对相关性进行了研究,并对教育、吸烟、饮酒、饮食、性别、肥胖、体力活动、研究调查进行了调整、和年龄(时间尺度)的相关性进行了研究,研究对象包括总体样本、高脂血症(n=2956)、高血压(n=8290)、肥胖(n=5784)、代谢综合征(n=1410)、吸烟者(n=3823)、不良饮食(n=3463)和缺乏运动者(n=6255)。结果 在14285名参与者(平均年龄±SD,53.7±11.4岁)中,有979人(6.9%)在随访期间(中位数,7.2年;第25-75位,5.3-14.6年)发生过心肌梗死。eCRF 中位数(32 mL/kg/min)女性的心肌梗死风险比参考值第 10 百分位数(25 mL/kg/min)女性低 43%(亚分布危险比 [SHR],0.57;95% CI,0.48-0.68)。47 毫升/千克/分钟时,心肌梗死风险最低(SHR,0.02;95% CI,0.01-0.11)。男性的心肌梗死风险在 eCRF 中位数(40 毫升/千克/分钟;SHR,0.74;95% CI,0.63-0.86)时比在第 10 百分位数(32 毫升/千克/分钟)时低 26%,在 60 毫升/千克/分钟时最低风险为 69%(SHR,0.31;95% CI,0.14-0.71)。结论女性和男性的 eCRF 越高,心肌梗死风险越低,但女性的相关性比男性更明显。这表明,eCRF 是医疗护理中识别未来心肌梗死高风险人群(尤其是女性)的重要估算指标。
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来源期刊
Mayo Clinic proceedings. Innovations, quality & outcomes
Mayo Clinic proceedings. Innovations, quality & outcomes Surgery, Critical Care and Intensive Care Medicine, Public Health and Health Policy
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