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Journal of Peking University(Health Sciences) ›› 2020, Vol. 52 ›› Issue (1): 152-157. doi: 10.19723/j.issn.1671-167X.2020.01.024

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Protective effect of cardiopulmonary fitness on patients with high risk of atherosclerotic cardiovascular disease

Chuan REN1,Xiao-yue WU1,Wei ZHAO1,2,△(),Li-yuan TAO3,Ping LIU1,Wei GAO1   

  1. 1. Department of Cardiology, Peking University Third Hospital; Institute of Vascular Medicine of Peking University Third Hospital; Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides of National Health Commission; Key Laboratory of Molecular Cardiovascular Science of Ministry of Education; Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing 100191, China
    2. Physical Examination Center, Peking University Third Hospital, Beijing 100191, China
    3. Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing 100191, China
  • Received:2019-09-24 Online:2020-02-18 Published:2020-02-20
  • Contact: Wei ZHAO E-mail:beate_vv@ bjmu.edu.cn
  • Supported by:
    Supported by the CS Optimizing Antithrombotic Research Fund(BJUHFCSOARF201801-11);Capital Clinical Application Research and Promotion Projects of Beijing Municipal Science and Technology Commission(Z151100004015047);National Natural Science Foundation of China(81601968)

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Abstract:

Objective: To evaluate the effects of cardiopulmonary fitness on arteriosclerotic cardiovascular disease (ASCVD) events in patients with different risks of ASCVD. Methods: This study enrolled 544 non ASCVD patients who underwent cardiopulmonary exercise testing in Peking University Third Hospital from September 2016 to April 2018. ASCVD overall risk assessment was conducted according to “Chinese Guidelines for the Prevention and Treatment of Adult Dyslipidemia”. Peak oxygen uptake (VO2peak), the classic indicator of cardiopulmonary fitness, was accurately determined by cardiopulmonary exercise testing in all the patients. All of the patients were followed up clinically. Results: In the study, 506 patients completed the follow-up (250 low-risk patients, 93 moderate-risk patients and 163 high-risk patients). The median follow-up period was 19 months (9-28 months), and 51 patients developed ASCVD events during the follow-up period, of whom, 33 cases developed myocardial infarction, unstable angina or coronary revascularization, and 18 cases ischemic stroke, transient ischemic attack or carotid vascular revascularization. The patients were divided into the ASCVD group (n=51) and the non ASCVD group (n=455) based on the presence or absence of ASCVD events. VO2peak [16.3(3.6) mL(kg·min) vs. 19.1(3.2) mL/(kg·min), P<0.001] in the ASCVD group were significantly lower than that in the non ASCVD group. Logistic regression analysis found VO2peak [OR 0.893 (95%CI:0.831-0.959), P=0.002] and ASCVD risk stratification [OR 1.428 (95%CI:1.028-1.878), P=0.031] were both independently associated with the occurrence of ASCVD events, which meant that every 1 mL/(kg·min) of increase in VO2peak, the risk of ASCVD events was reduced by 11%. The patients were divided into low, moderate, and high VO2peak according to the tertiles of their VO2peak [14.4 mL/(kg·min), and 23.0 mL/(kg·min)]. Logistic regression analyses were performed using ASCVD events as a dependent variable in the patients with high-risk and low/moderate-risk of ASCVD respectively. In the patients with high-risk of ASCVD, the results suggested that the incidence of ASCVD events was significantly decreased in the patients with moderate VO2 peak [OR 0.210 (95%CI:0.054-0.814), P=0.024] and high VO2 peak [OR 0.146 (95%CI:0.025-0.870), P=0.035], but no significant effect of VO2 peak elevation on the incidence of ASCVD events was found in the low/moderate-risk ASCVD patients. Conclusion: High cardiopulmonary fitness can significantly reduce the occurrence of ASCVD events in patients with high-risk of ASCVD.

Key words: Arteriosclerotic cardiovascular disease, Risk stratification, Cardiopulmonary exercise testing, Cardiorespiratory fitness

CLC Number: 

  • R541.4

Table 1

General information of ASCVD group and non ASCVD group"

Items Non ASCVD group(n=455) ASCVD group(n=51) P
Age/years, x?±s 56.0±13.1 63.7±9.2 <0.001
Gender 0.084
Male, n(%) 224(49.2) 32(62.7)
Female, n (%) 231(50.8) 19(37.3)
BMI/(kg/m2), x?±s 25.3±3.8 26.2±3.0 0.105
Medical History
Hypertension, n (%) 189(41.5) 30(58.8) 0.023
Hyperlipidemia, n (%) 196(43.1) 25(49.0) 0.473
Diabetes, n (%) 82(18.0) 13(25.5) 0.215
Smoking, n (%) 118(25.9) 17(33.3) 0.287
Laboratory tests
TC/(mmol/L), x?±s 4.71±0.97 4.43±1.18 0.058
LDL-C/(mmol/L), M(IQR) 1.88(1.01) 2.13(0.71) 0.616
HDL-C/(mmol/L), M(IQR) 1.16(0.20) 1.05(0.22) 0.011
TG/(mmol/L), x?±s 2.53±1.02 2.31±1.04 0.163
FBG/(mmol/L), M(IQR) 5.5(0.7) 5.7(0.8) 0.805
HbAlc, n (%) 5.9(0.6) 6.1(0.8) 0.433
Medication
ACEI/ARB, n (%) 73(16.0) 13(25.4) 0.204
β-blockers, n (%) 54(11.9) 8(15.7) 0.456
Calcium channel blockers, n (%) 82(18.0) 16(31.4) 0.026
Statins, n (%) 103(22.6) 23(45.1) 0.001
Aspirin, n (%) 60(13.2) 19(37.3) <0.001
Cardiopulmonary exercise testing
VO2peak/[mL/(kg·min)], M(ITR) 19.1(3.2) 16.3(3.6) <0.001
Positive result, n (%) 30(6.6) 4(7.8) 0.189

Table 2

General information of ASCVD group and non ASCVD group in ASCVD low /moderate risk and high risk populations"

Items Low /moderate risk High risk
Non ASCVD group
(n=313)		 ASCVD group
(n=30)		 P Non ASCVD group
(n=142)		 ASCVD group
(n=21)		 P
Age/years, x?±s 55.3±13.6 65.1±9.1 <0.001 57.6±11.6 61.8±9.2 0.117
Gender 0.152 0.479
Male, n(%) 145(46.3) 18(60.0) 79(55.6) 14(66.7)
Female, n (%) 168(53.7) 12(40.0) 63(44.4) 7(33.3)
BMI, kg/m2 24.8±3.5 26.2±2.8 0.039 26.6±4.0 26.3±3.4 0.740
Medical History
Hypertension, n (%) 93(29.7) 14(46.7) 0.056 96(67.7) 16(76.2) 0.630
Hyperlipidemia, n (%) 121(38.6) 12(40.0) 0.885 75(52.8) 13(61.9) 0.585
Diabetes, n (%) 6(1.9) 2(6.7) 0.100 76(53.5) 11(52.4) 0.737
Smoking, n (%) 60(19.2) 8(26.7) 0.325 58(40.8) 9(42.9) 0.993
Laboratory tests
TC/(mmol/L), x?±s 4.66±0.90 4.16±1.04 0.005 4.84±1.09 4.83±1.29 0.957
LDL-C/(mmol/L), M(IQR) 1.75(1.02) 1.74(1.22) 0.637 2.26(0.77) 2.46(0.74) 0.186
HDL-C/(mmol/L), M(IQR) 1.20(0.19) 1.11(0.20) 0.084 1.02(0.20) 0.90(0.33) 0.326
TG/(mmol/L), x?±s 2.41±0.97 2.06±0.80 0.052 2.80±1.07 2.66±1.24 0.588
FBG/(mmol/L), M(IQR) 5.4(0.5) 5.6(0.3) 0.735 6.4(1.6) 6.2(1.6) 0.341
HbAlc, n (%) 5.7(0.3) 5.7(0.5) 0.575 6.5(1.5) 6.6(1.3) 0.961
Medication
ACEI/ARB, n (%) 41(13.1) 5(16.7) 0.584 32(22.5) 8(38.1) 0.122
β-blockers, n (%) 32(10.2) 3(10.0) 0.969 22(15.5) 5(23.8) 0.397
Calcium channel blockers, n (%) 45(14.4) 9(30.0) 0.025 37(26.1) 7(33.3) 0.575
Statins, n (%) 70(22.3) 14(46.7) 0.004 33(23.2) 9(42.9) 0.052
Aspirin, n (%) 43(13.7) 10(33.3) 0.005 17(12.0) 9(42.9) 0.001
Cardiopulmonary exercise testing
VO2peak, mL/(kg·min), M(ITR) 19.4(3.1) 16.1(4.4) 0.006 18.8(2.8) 16.3(1.7) 0.014
Positive result, n (%) 16(5.1) 2(6.7) 0.340 14(9.9) 2(9.5) 0.242

Figure 1

Logistic regression analysis of ASCVD events by categories of VO2peak in ASCVD low /moderate risk and high risk populations Model is adjusted for age, gender, BMI, TC, calcium channel blockers use, statin use, aspirin use. VO2peak, peak oxygen uptake; ASCVD, arteriosclerotic cardiovascular disease; BMI, body mass index; TC, total cholesterol; OR, odds ratio."

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