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Higher exercise capacity may reduce mortality risk after first MI
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Higher levels of fitness may not only reduce risk for MI, but also improve chances of survival after a first attack, researchers reported in Mayo Clinic Proceedings.
“We knew that fitter people generally live longer, but we now have evidence linking fitness to survival after a first [MI],” Michael J. Blaha, MD, MPH, director of clinical research for the Ciccarone Center for the Prevention of Heart Disease and assistant professor of medicine at the Johns Hopkins University School of Medicine, said in a press release. “It makes sense, but we believe this is the first time there is documentation of that association.”
Michael J. Blaha
The researchers conducted a retrospective cohort study of 2,061 participants (38% women; 56% white; median age, 62 years) without a history of MI from the Henry Ford exercise testing project. All participants underwent clinical treadmill testing from 1991 to May 2009 and then had MI during follow-up. The mean time from the exercise test to MI was 6 years. Exercise capacity was measured as estimated metabolic equivalents (METs) achieved: less than 6, 6 to 9, 10 to 11, and 12 or more. The researchers defined early mortality as all-cause mortality within 28, 90 or 365 days after MI.
According to results, 28-day early mortality rate was 10.6% overall, and 13.9%, 10.7%, 6.9% and 6% in the less than 6, 6 to 9, 10 to 11 and 12 or more METs categories, respectively. The 219 patients who had 28-day early mortality were more likely to be older, have a lower baseline exercise capacity and a longer duration of time between the exercise test and the MI. These patients were also more likely to have a history of hypertension (P < .05).
The early mortality rate at 90 days was 15.7%, and 24.5% at 365 days. A 1-MET higher exercise capacity was associated with an 8% to 10% lower mortality risk at 28 days (OR = 0.92; 95% CI, 0.87-0.98), 90 days (OR= 0.9; 95% CI, 0.86-0.95) and 365 days (OR = 0.91; 95% CI, 0.87-0.94).
“Our data suggest that doctors working with patients who have [CV] risk factors should be saying, ‘Mr. Jones, you need to start an exercise program now to improve your fitness and chances of survival, should you experience [an MI],’” Clinton A. Brawner, PhD, clinical exercise physiologist at Henry Ford Health System, said in the release.
The researchers called for follow-up studies to establish a more direct relationship between fitness level as measured by MET scores and mortality risk after first MI, as well as address whether fitter people had less damaging MIs or just a better survival rate. – by Tracey Romero
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Joseph S. Alpert, MD
This study is yet one more piece of evidence for what has been known for a very long time — that is, regular exercise leading to fitness markedly reduces the risk for MI and death from ischemic heart disease. There continues to be considerable debate about what diet one should follow to reduce heart disease risk, but there is no debate about exercise: 100% of studies show benefit. That is why my personal mantra which I repeat every day for patients is: ‘You only need to exercise on the days that you eat.’
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