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Prev Med. 2018 Jan;106:137-144. doi: 10.1016/j.ypmed.2017.10.025. Epub 2017 Nov 2.

Clinical importance of non-participation in a maximal graded exercise test on risk of non-fatal and fatal cardiovascular events and all-cause mortality: CARDIA study.

Author information

1
UTHealth School of Public Health in Austin, Department of Epidemiology, Human Genetics, and Environmental Sciences, Michael & Susan Dell Center for Healthy Living, Austin, TX 78701, USA; The University of Texas at Austin, Dell Medical School, Department of Women's Health, Austin, TX 78712, USA. Electronic address: Kelley.P.Gabriel@uth.tmc.edu.
2
University of Minnesota School of Public Health, Division of Epidemiology & Community Health, Minneapolis, MN 55454, USA.
3
University of Minnesota School of Medicine, Cardiovascular Division, Minneapolis, MN 55455, USA.
4
Kaiser Permanente Northern California, Division of Research, Oakland, CA 94612, USA.
5
University of Alabama at Birmingham, Division of Preventive Medicine, Birmingham, AL 35205, USA.
6
UTHealth School of Public Health in Austin, Department of Epidemiology, Human Genetics, and Environmental Sciences, Michael & Susan Dell Center for Healthy Living, Austin, TX 78701, USA.

Abstract

While poor performance during a maximal graded exercise test (GXT) predicts cardiovascular events and premature mortality, the potential clinical importance of non-participation in a GXT, either for medical or non-medical reasons, is currently unknown. Data are from 4086 and 3547 Coronary Artery Risk Development in Young Adults (CARDIA) participants who attended the Year 7 (ages 25-37years) and/or 20 exams (ages 38-50years), respectively, which included a GXT. Cox proportional hazard models were used to examine the effect of GXT disposition (at Year 7 and 20, separately) on risk of non-fatal and fatal cardiovascular events and all-cause mortality obtained through 28years of follow-up. A GXT was not conducted or completed according to protocol in 12.9% and 19.1% of participants attending the Year 7 and 20 exams, respectively. After adjustment, participants who missed the Year 20 GXT for medical reasons had a higher risk of cardiovascular events [HR: 4.06 (95% CI: 1.43, 11.5)] and all-cause mortality [HR: 3.07 (95% CI: 1.11, 12.3)] compared to GXT completers; participants who missed at Year 20 for non-medical reasons also had higher risk of all-cause mortality [HR: 2.53 (95% CI: 1.61, 3.99)]. Findings suggest that non-participation in a GXT, regardless of medical or non-medical reason, to be an important predictor of excess risk of adverse health outcomes and premature mortality. Additional patient follow-up, including identification of potential targets for intervention (e.g., weight management and smoking cessation programs), should be conducted at the point of a missed GXT.

KEYWORDS:

Adverse events; Cardiorespiratory fitness; Cohort studies; Risk prediction

PMID:
29080827
PMCID:
PMC6400469
DOI:
10.1016/j.ypmed.2017.10.025
[Indexed for MEDLINE]
Free PMC Article

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