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

Kelley Pettee Gabriel, Kara M. Whitaker, Daniel Duprez, Barbara Sternfeld, Cora E. Lewis, Steve Sidney, Gregory Knell, David R. Jacobs

Research output: Contribution to journalArticle

1 Citation (Scopus)

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 25–37 years) and/or 20 exams (ages 38–50 years), 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 28 years 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.

Original languageEnglish (US)
Pages (from-to)137-144
Number of pages8
JournalPreventive Medicine
Volume106
DOIs
StatePublished - Jan 1 2018

Fingerprint

Exercise Test
Young Adult
Coronary Vessels
Mortality
Premature Mortality
Social Adjustment
Smoking Cessation
Proportional Hazards Models
Weights and Measures
Health

Keywords

  • Adverse events
  • Cardiorespiratory fitness
  • Cohort studies
  • Risk prediction

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Intramural
  • Research Support, U.S. Gov't, P.H.S.

Cite this

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. / Pettee Gabriel, Kelley; Whitaker, Kara M.; Duprez, Daniel; Sternfeld, Barbara; Lewis, Cora E.; Sidney, Steve; Knell, Gregory; Jacobs, David R.

In: Preventive Medicine, Vol. 106, 01.01.2018, p. 137-144.

Research output: Contribution to journalArticle

Pettee Gabriel, Kelley ; Whitaker, Kara M. ; Duprez, Daniel ; Sternfeld, Barbara ; Lewis, Cora E. ; Sidney, Steve ; Knell, Gregory ; Jacobs, David R. / 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. In: Preventive Medicine. 2018 ; Vol. 106. pp. 137-144.
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