Addition of estimated cardiorespiratory fitness to the clinical assessment of 10-year coronary heart disease risk in asymptomatic men

Abstract

The Framingham Risk Score (FRS) was developed to quantify a patient's coronary heart disease (CHD) risk. Non-exercise estimated CRF (e-CRF) may provide a clinically practical method for describing cardiorespiratory fitness. We computed e-CRF and tested its association with the FRS and CHD.Male participants (n = 29,854) in the Aerobics Center Longitudinal Study (ACLS) who completed a baseline examination between 1979–2002 were followed for 12 years to determine incident CHD defined by self-report of myocardial infarction, revascularization, or CHD mortality. e-CRF was defined from a 7-item scale and categorized using age-specific tertiles. Multivariable survival analysis determined associations between FRS, e-CRF, and CHD. Interaction between e-CRF and FRS was tested by stratified analysis by ‘low’ and ‘moderate or high’ 10-year CHD risk.Men with high e-CRF were significantly (p-value < 0.0001) younger, and less likely to be smokers, compared to men with low e-CRF. Multivariable survival analysis reported men with high e-CRF were 29% (HR = 0.71; 95% 0.56, 0.88) less likely to experience a CHD event compared to men with low e-CRF. Stratified analyses showed men with ‘low’ 10-year FRS predicted CHD risk and high e-CRF had a 28% (HR = 0.72; 95% CI 0.57, 0.91) lower CHD-mortality risk compared to men with low e-CRF, no association was found in this group and men with moderate e-CRF. Men who were more fit had a decreased risk for CHD compared to men in the lowest third of fitness. Estimated CRF may add clinical value to the FRS and help clinicians better predict long-term CHD risk.

The role of cardiorespiratory fitness on the risk of sudden cardiac death at the population level: A systematic review and meta-analysis of the available evidence

“…estimated-CRF (eCRF) from readily available clinical or research data base information has been suggested as a good alternative to objective CRF measurement, 18,38 as it can be quickly and easily collected in epidemiological studies with good correlations with measured CRF and favorable predictive value for CVD events and mortality.…”

Cardiorespiratory fitness and incident lung and colorectal cancer in men and women: Results from the Henry Ford Exercise Testing (FIT) cohort

“…Cardiorespiratory fitness (CRF) is a measure of peak energy expenditure, often expressed in metabolic equivalents of task (METs), and reflects a combination of physical activity, inherited factors, and several host factors, including age, and the overall functional health of multiple organ systems . Compared with physical activity alone, CRF is a better predictor of cardiovascular disease and all‐cause mortality and improves the risk classification of cardiovascular disease when added to traditional risk factors …”

“…2,3 Compared with physical activity alone, CRF is a better predictor of cardiovascular disease and all-cause mortality 2,4 and improves the risk classification of cardiovascular disease when added to traditional risk factors. 5,6 Given the association between decreased physical activity and increased cancer incidence, CRF also may improve risk stratification in patients with cancer. 7 First, cancer and cardiovascular disease share modifiable risk factors, including lower levels of physical activity.…”

Promoting the Assessment of Physical Activity and Cardiorespiratory Fitness in Assessing the Role of Vascular Risk on Cognitive Decline in Older Adults

“…In these studies, authors found that among men with “low” 10-year FRS predicted CHD risk, those with high eCRF had a lower risk for CHD compared to men with low eCRF. These results suggest that assessing eCRF from research data or clinical information that is easy to obtain may considerably add to the clinicians' overall risk assessment using FRS (Gander et al, 2017). Thus, eCRF could be a good alternative to objective CRF measurement as it can be quickly and easily collected in epidemiological studies and implemented in the assessment of lifestyle factors with Aβ burden, cognitive decline with aging, and Alzheimer disease.…”

“…However, self-reported PA has been widely used at epidemiological level when a more objective measurement has not been available (Lee, 2018). In addition, recently it has been proven that estimated-CRF (eCRF), based on information easy to obtain (i.e., eCRF, estimated on the basis of sex, age, body mass index, waist circumference, resting heart rate, physical activity level and smoking status) adds to the clinical assessment of 10-year CHD risk in asymptomatic men (Artero et al, 2014; Gander et al, 2017). In these studies, authors found that among men with “low” 10-year FRS predicted CHD risk, those with high eCRF had a lower risk for CHD compared to men with low eCRF.…”