Another big win for cardiorespiratory fitness now in aortic valve disease

Spanning several decades, numerous studies have emphasized the critical roles of physical activity (PA), exercise training (ET) and, especially, cardiorespiratory fitness (CRF) in the primary and secondary prevention of cardiovascular diseases (CVD), including coronary heart disease (CHD) and heart failure (HF) [1–3]. More recently, studies have also demonstrated the benefits of CRF for non-CVD [4]. However, there has been relatively little evidence for the benefits of CRF in valvular heart disease (VHD), including aortic stenosis (AS). In this issue of the European Journal of Cardio-Thoracic Surgery (EJCTS), Smenes et al. [5] from the HUNT study in Norway reported on a cohort of 57 214 participants to assess the impact of CRF on the need for aortic valve replacement (AVR) for AS, as well as the impact of CRF on mortality following AVR. They demonstrated a 15% lower risk for AVR for every 1-metabolic equivalent (MET) increase in CRF, and those in the highest 20th percentile of CRF had a 56% lower risk for AVR compared to those in the lowest quintile. On the other hand, PA, which is a primary contributor to the increase in CRF, did not have a significant relationship with AVR. Following AVR, there was a 35% lower risk of postoperative mortality for every 1-MET increase in CRF. They concluded that higher CRF protected against the need for AVR as well as mortality risk following AVR.