Fitness increases survival rates regardless of CV burden in elderly
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.
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.
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.