Journal article
Clinical importance of non-participation in a maximal graded exercise test on risk of non-fatal and fatal cardiovascular events and all-cause mortality: CARDIA study
Preventive medicine, Vol.106, pp.137-144
01/2018
DOI: 10.1016/j.ypmed.2017.10.025
PMCID: PMC6400469
PMID: 29080827
Abstract
While poor performance during a maximal graded exercise test (GXT) predicts cardiovascular events and premature mortality, the potential clinical importance of non-participation in a GXT, either for medical or non-medical reasons, is currently unknown. Data are from 4086 and 3547 Coronary Artery Risk Development in Young Adults (CARDIA) participants who attended the Year 7 (ages 25–37years) and/or 20 exams (ages 38–50years), respectively, which included a GXT. Cox proportional hazard models were used to examine the effect of GXT disposition (at Year 7 and 20, separately) on risk of non-fatal and fatal cardiovascular events and all-cause mortality obtained through 28years of follow-up. A GXT was not conducted or completed according to protocol in 12.9% and 19.1% of participants attending the Year 7 and 20 exams, respectively. After adjustment, participants who missed the Year 20 GXT for medical reasons had a higher risk of cardiovascular events [HR: 4.06 (95% CI: 1.43, 11.5)] and all-cause mortality [HR: 3.07 (95% CI: 1.11, 12.3)] compared to GXT completers; participants who missed at Year 20 for non-medical reasons also had higher risk of all-cause mortality [HR: 2.53 (95% CI: 1.61, 3.99)]. Findings suggest that non-participation in a GXT, regardless of medical or non-medical reason, to be an important predictor of excess risk of adverse health outcomes and premature mortality. Additional patient follow-up, including identification of potential targets for intervention (e.g., weight management and smoking cessation programs), should be conducted at the point of a missed GXT.
•Few studies have examined the importance of missing a maximal graded exercise test.•Findings confirm an increased risk of events in those meeting medical exclusions.•Findings suggest an increased risk of death in those missing for other reasons.•Findings support future research in this area using a clinical population.
Details
- Title: Subtitle
- Clinical importance of non-participation in a maximal graded exercise test on risk of non-fatal and fatal cardiovascular events and all-cause mortality: CARDIA study
- Creators
- Kelley Pettee Gabriel - UTHealth School of Public Health in Austin, Department of Epidemiology, Human Genetics, and Environmental Sciences, Michael & Susan Dell Center for Healthy Living, Austin, TX 78701, USAKara M Whitaker - University of Minnesota School of Public Health, Division of Epidemiology & Community Health, Minneapolis, MN 55454, USADaniel Duprez - University of Minnesota School of Medicine, Cardiovascular Division, Minneapolis, MN 55455, USABarbara Sternfeld - Kaiser Permanente Northern California, Division of Research, Oakland, CA 94612, USACora E Lewis - University of Alabama at Birmingham, Division of Preventive Medicine, Birmingham, AL 35205, USASteve Sidney - Kaiser Permanente Northern California, Division of Research, Oakland, CA 94612, USAGregory Knell - UTHealth School of Public Health in Austin, Department of Epidemiology, Human Genetics, and Environmental Sciences, Michael & Susan Dell Center for Healthy Living, Austin, TX 78701, USADavid R Jacobs - University of Minnesota School of Public Health, Division of Epidemiology & Community Health, Minneapolis, MN 55454, USA
- Resource Type
- Journal article
- Publication Details
- Preventive medicine, Vol.106, pp.137-144
- DOI
- 10.1016/j.ypmed.2017.10.025
- PMID
- 29080827
- PMCID
- PMC6400469
- NLM abbreviation
- Prev Med
- ISSN
- 0091-7435
- eISSN
- 1096-0260
- Publisher
- Elsevier Inc
- Language
- English
- Date published
- 01/2018
- Academic Unit
- Epidemiology; Health, Sport, and Human Physiology
- Record Identifier
- 9984002328802771
Metrics
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