Exercise workload, coronary risk evaluation and the risk of cardiovascular and all-cause death in middle-aged men

BACKGROUND: No data exist on exercise workload combined with European Systematic Coronary Risk Evaluation (SCORE) with respect to death from cardiovascular diseases and other causes. We therefore investigated the prognostic significance of risk scores and exercise capacity with respect to cardiovascular diseases. DESIGN: A population-based follow-up study. METHODS: Exercise workload was measured by exercise test with an electrically braked cycle ergometer. The study is based on a random population-based sample of 1639 men (42-60 years) without history of type II diabetes or atherosclerotic cardiovascular disease including coronary heart disease, stroke or claudication. RESULTS: During an average follow-up of 16 years, a total of 304 overall deaths and 116 cardiovascular deaths occurred. Relative risk (RR) was 2.50 [95% confidence intervals (CI): 1.71-3.68, P<0.001] for all-cause death and 2.04 (95% CI: 1.14-3.65, P=0.016) for cardiovascular death among men with exercise capacity less than 162 W as compared with those with exercise capacity over 230 W, after adjustment for risk factors. Independent predictors for all-cause death were European SCORE (for 1% increment, RR: 1.15, 95% CI: 1.10-1.20, P<0.001), exercise workload (for 20 W increment, RR: 0.86, 95% CI: 0.82-0.91, P<0.001), C-reactive protein and alcohol consumption, when adjusted for serum high-density lipoprotein, body mass index, family history of coronary heart disease, exercise-induced ST changes and the use of medications for hypertension, dyslipidemia or aspirin. CONCLUSION: Low exercise workload predicts an especially high risk for death from cardiovascular and any other cause when combined with high risk SCORE.