Meeting NewsPerspective

Fitness increases survival rates regardless of CV burden in elderly

Seamus Whelton
Seamus Whelton

NEW ORLEANS — Increased fitness in adults aged at least 70 years may lead to better survival rates despite CVD risk factor burden, according to findings presented at the American College of Cardiology Scientific Session.

Seamus Whelton, MD, MPH, assistant professor of medicine at the division of cardiology at Johns Hopkins Medicine, and colleagues sought to determine whether fitness could improve risk stratification among older adults at the extremes of CVD risk factor burden.

“We know that fitness is a very strong predictor of CVD outcome and also total mortality. So, we wanted to see the number of risk factors,” Whelton told Cardiology Today. “The one thing I want to make sure is that we’re not saying that controlling your blood pressure or your cholesterol or your diabetes isn’t important. We’re looking specifically at just the number of risk factors, but not how well they’re controlled, and there’s lots of very good evidence to speak to controlling BP, cholesterol, etc, in this age group.”

Whelton and colleagues analyzed data of 6,509 patients aged at least 70 years without CVD from the Henry Ford Exercise Testing (FIT) Project.

Patients underwent a physician-referred treadmill stress test and were divided into three groups: less than 6 metabolic equivalents of task (METs; least fit), 6 to 9.9 METs (moderately fit), and 10 or more METs (most fit). Traditional CVD risk factors were summed from zero to at least three.

The researchers identified 2,526 deaths during a mean follow-up of 9 years in patients (mean age, 75 years; 52% women).

Mortality rate per 1,000 person-years was approximately 55 for the least fit group and 25 for the most fit group regardless of factors, Whelton and colleagues wrote in an abstract.

Increased fitness in adults aged at least 70 years may lead to better survival rates despite CVD risk factor burden, according to findings presented at the American College of Cardiology Scientific Session.
Source: Shutterstock

Higher fitness, but not a lower number of risk factors, was associated with improved survival, the researchers wrote.

In an adjusted Cox model, older adults with three or more risk factors with moderate fitness had reduced mortality rate (mortality hazard = 0.64; 95% CI, 0.54-0.76) when compared with the least fit group, Whelton and colleagues wrote.

Older adults with three or more risk factors and high fitness also had a reduced mortality hazard (0.47; 95% CI, 0.36-0.62) compared with the least fit.

“In this age group, we know risk stratification using traditional cardiovascular risk factors is very difficult. Fitness does a very good job of risk stratification of long-term risk of mortality,” Whelton said. “Fitness is a simple low-cost strategy for risk stratification that should probably be more widely utilized, especially in older individuals whom risk stratification is more difficult.” – by Earl Holland Jr.

Reference:

Whelton S, et al. Abstract 1126-336. Presented at: American College of Cardiology Scientific Session; March 16-18, 2019; New Orleans.

Disclosure: Whelton reports no relevant financial disclosures.

Seamus Whelton
Seamus Whelton

NEW ORLEANS — Increased fitness in adults aged at least 70 years may lead to better survival rates despite CVD risk factor burden, according to findings presented at the American College of Cardiology Scientific Session.

Seamus Whelton, MD, MPH, assistant professor of medicine at the division of cardiology at Johns Hopkins Medicine, and colleagues sought to determine whether fitness could improve risk stratification among older adults at the extremes of CVD risk factor burden.

“We know that fitness is a very strong predictor of CVD outcome and also total mortality. So, we wanted to see the number of risk factors,” Whelton told Cardiology Today. “The one thing I want to make sure is that we’re not saying that controlling your blood pressure or your cholesterol or your diabetes isn’t important. We’re looking specifically at just the number of risk factors, but not how well they’re controlled, and there’s lots of very good evidence to speak to controlling BP, cholesterol, etc, in this age group.”

Whelton and colleagues analyzed data of 6,509 patients aged at least 70 years without CVD from the Henry Ford Exercise Testing (FIT) Project.

Patients underwent a physician-referred treadmill stress test and were divided into three groups: less than 6 metabolic equivalents of task (METs; least fit), 6 to 9.9 METs (moderately fit), and 10 or more METs (most fit). Traditional CVD risk factors were summed from zero to at least three.

The researchers identified 2,526 deaths during a mean follow-up of 9 years in patients (mean age, 75 years; 52% women).

Mortality rate per 1,000 person-years was approximately 55 for the least fit group and 25 for the most fit group regardless of factors, Whelton and colleagues wrote in an abstract.

Increased fitness in adults aged at least 70 years may lead to better survival rates despite CVD risk factor burden, according to findings presented at the American College of Cardiology Scientific Session.
Source: Shutterstock

Higher fitness, but not a lower number of risk factors, was associated with improved survival, the researchers wrote.

In an adjusted Cox model, older adults with three or more risk factors with moderate fitness had reduced mortality rate (mortality hazard = 0.64; 95% CI, 0.54-0.76) when compared with the least fit group, Whelton and colleagues wrote.

Older adults with three or more risk factors and high fitness also had a reduced mortality hazard (0.47; 95% CI, 0.36-0.62) compared with the least fit.

“In this age group, we know risk stratification using traditional cardiovascular risk factors is very difficult. Fitness does a very good job of risk stratification of long-term risk of mortality,” Whelton said. “Fitness is a simple low-cost strategy for risk stratification that should probably be more widely utilized, especially in older individuals whom risk stratification is more difficult.” – by Earl Holland Jr.

Reference:

Whelton S, et al. Abstract 1126-336. Presented at: American College of Cardiology Scientific Session; March 16-18, 2019; New Orleans.

Disclosure: Whelton reports no relevant financial disclosures.

    Perspective
    Michael S. Emery

    Michael S. Emery

    Henry Ford is very known for studies like this, as they have a very rich and robust database. There’s always this fear of cardiac complications in the elderly, particularly those that have risk factors.

    But I think this sort of helps to alleviate some of those concerns that the fitness should be what’s driving what we do for these patients in that age group. No matter how many risk factors they had, which we tried to control with medications, the fitness seemed to trump, and that’s a big deal.

    We’ve always known that fitness is a good predictor of CV risks and outcomes.

    That was mostly in younger patients, so this was not overly well-explored in an elderly population.

    What it adds on the knowledge base is that, by itself, it is a better predictor of risk factors, which we always used in the past to guide our risk stratification and our goals of therapy with the number of risk factors they had.

    When we try to educate them, now it seems like fitness ought to be playing a much larger role than in the past.

    Any time we talk about health and wellness in a population, exercise is always a piece, but nutrition must be a piece as well.

    This study doesn’t get into any nutritional factors, which is controversial about what’s proper nutrition these days, but that doesn’t get into nutritional pieces, which can’t be ignored any time you’re talking about health and wellness.

    It has to be about nutrition and exercise.

    • Michael S. Emery, MD, MS, FACC
    • Assistant Professor of Clinical Medicine
      Krannert Institute of Cardiology
      Indiana University School of Medicine
      Medical Director, Center for Cardiovascular Care In Athletics
      Indiana University Health

    Disclosures: Emery reports no relevant financial disclosures.

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