Key result
Decreased exercise capacity (<85% of predicted) independently increased the risk of major adverse cardiovascular events, with a hazard ratio of 3.3 in nondiabetics and 2.7 in diabetics.
Why the study?
Does decreased exercise capacity (<85% of predicted) independently predict major adverse cardiovascular events in diabetic and nondiabetic patients without known CAD?
Cohort (n=894)
No
Does decreased exercise capacity (<85% of predicted) independently predict major adverse cardiovascular events in diabetic and nondiabetic patients without known CAD?
Supports exercise capacity for risk stratification without known CAD; hypothesis-generating for intervention trials in diabetics and nondiabetics.
INTRODUCTION: To investigate if decreased exercise capacity is an independent risk factor for major adverse cardiovascular events (MACE) in diabetics and nondiabetics. MATERIAL AND METHODS: The association of decreased exercise capacity (EC) during a treadmill exercise sestamibi stress test with MACE was investigated in 490 nondiabetics and 404 diabetics. Mean follow-up was 53 months. RESULTS: Nondiabetics with a predicted EC < 85% had a higher prevalence of myocardial ischemia (34% vs. 19%, p = 0.0002), 2- or 3-vessel obstructive coronary artery disease (CAD) (31% vs. 13%, p = 0.016), myocardial infarction (MI) (17% vs. 7%, p = 0.0005), stroke (8% vs. 2%, p = 0.002), death (11% vs. 3%, p = 0.0002), and MI or stroke or death at follow-up (32% vs. 11%, p < 0.001) compared to nondiabetics with a predicted EC ≥ 85%. Diabetics with a predicted EC < 85% had a higher prevalence of myocardial ischemia (48% vs. 32%, p = 0.0009), 2- or 3-vessel obstructive CAD (54% vs. 28%, p = 0.001), MI (32% vs. 14%, p < 0.001), stroke (22% vs. 6%, p < 0.001), death (17% vs. 9%, p = 0.031), and MI or stroke or death at follow-up (65% vs. 27%, p < 0.001). Stepwise Cox regression analysis showed decreased EC was an independent and significant risk factor for MACE among nondiabetics (hazard ratio 3.3, p < 0.0001) and diabetics (hazard ratio 2.7, p < 0.0001). CONCLUSIONS: Diabetics and nondiabetics with decreased EC were at increased risk for MACE with nondiabetics and decreased EC at similar risk as diabetics with normal EC.
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Pierre-Louis et al. (2014) conducted a cohort in Suspected coronary artery disease (chest pain or dyspnea) (n=894). Decreased exercise capacity (<85% of predicted) vs. Normal exercise capacity (≥85% of predicted) was evaluated on Time to myocardial infarction, stroke, or death (MACE) in nondiabetics (HR 3.3, 95% CI 2.2-5.1, p=<0.0001). Decreased exercise capacity (<85% of predicted) independently increased the risk of major adverse cardiovascular events, with a hazard ratio of 3.3 in nondiabetics and 2.7 in diabetics.
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