January 1, 2014Archives of Medical Science15 citationsOpen Access

Exercise capacity as an independent risk factor for adverse cardiovascular outcomes among nondiabetic and diabetic patients

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Suspected coronary artery disease (chest pain or dyspnea) (n=894). Intervention: Decreased exercise capacity (<85% of predicted) vs. Normal exercise capacity (≥85% of predicted). Primary outcome: Time to myocardial infarction, stroke, or death (MACE) in nondiabetics (HR 3.3, 95% CI 2.2-5.1, p=<0.0001).

BPBredy Pierre-Louis AGAchuta Kumar Guddati MSMuhammad K. Hayat Syed

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.

Study Design

Type

Cohort (n=894)

Multicenter

Structured PICO

Does decreased exercise capacity (<85% of predicted) independently predict major adverse cardiovascular events in diabetic and nondiabetic patients without known CAD?

Population

894 patients (490 nondiabetics and 404 diabetics) with no history of coronary artery disease referred for a stress test due to chest pain or dyspnea, followed for a mean of 53 months.

Exposure

Decreased exercise capacity, defined as achieving < 85% of maximal age- and sex-predicted metabolic equivalents (METs) during a symptom-limited treadmill exercise sestamibi stress test.

Comparator

Normal exercise capacity, defined as achieving ≥ 85% of maximal age- and sex-predicted metabolic equivalents (METs) during the same stress test.

Outcome

Time to the development of myocardial infarction, stroke, or death at mean 53 months follow-up.composite

Main Result

Hazard Ratio: 3.3 (95% CI 2.2–5.1)

Absolute Event Rate: 32% vs 11%

p-value: p=<0.0001

Limitations

Single center study
High-risk cohort involving a primarily African-American and Latino population, limiting generalizability to other populations
Single center

Abstract

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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Cite This Study

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.

synapsesocial.com/papers/6a7daf93cecc27a187a145ba https://doi.org/https://doi.org/10.5114/aoms.2014.40731

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