Midlife Cardiorespiratory Fitness and the Development of Peripheral Artery Disease in Later Life
Background Data are sparse on the prospective associations between physical activity and incidence of lower extremity peripheral artery disease (PAD). Methods and Results Linking participant data from the CCLS (Cooper Center Longitudinal Study) to Medicare claims files, we studied 19 023 participant...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2021-12-01
|
| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.121.020841 |
| _version_ | 1827143869858316288 |
|---|---|
| author | Neil Keshvani Benjamin Willis David Leonard Ang Gao Laura DeFina Mary M. McDermott Jarett D. Berry Dharam J. Kumbhani |
| author_facet | Neil Keshvani Benjamin Willis David Leonard Ang Gao Laura DeFina Mary M. McDermott Jarett D. Berry Dharam J. Kumbhani |
| author_sort | Neil Keshvani |
| collection | DOAJ |
| description | Background Data are sparse on the prospective associations between physical activity and incidence of lower extremity peripheral artery disease (PAD). Methods and Results Linking participant data from the CCLS (Cooper Center Longitudinal Study) to Medicare claims files, we studied 19 023 participants with objectively measured midlife cardiorespiratory fitness through maximal effort on the Balke protocol who survived to receive Medicare coverage between 1999 and 2009. The study aimed to determine the association between midlife cardiorespiratory fitness and incident PAD with proportional hazards intensity models, adjusted for age, sex, body mass index, and other covariates, to PAD failure time data. During 121 288 person‐years of Medicare follow‐up, we observed 805 PAD‐related hospitalizations/procedures among 19 023 participants (21% women, median age 50 years). Lower midlife fitness was associated with a higher rate of incident PAD in patients aged 65 years and older (low fit [quintile 1]: 11.4, moderate fit [quintile 2 to 3]: 7.8, and high fit [quintile 4 to 5]: 5.7 per 1000 person years). After multivariable adjustment for common predictors of incident PAD such as age, body mass index, hypertension, and diabetes, these findings persisted. Lower risk for PAD per greater metabolic equivalent task of fitness was observed (hazard ratio [HR], 0.93 [95% CI, 0.90–0.97]; P<0.001). Among a subset of patients with an additional fitness assessment, each 1 metabolic equivalent task increase from baseline fitness was associated with decreased risk of incident PAD (HR, 0.90 [95% CI, 0.82–0.99]; P=0.03). Conclusions Cardiorespiratory fitness in healthy, middle‐aged adults is associated with lower risk of incident PAD in later life, independent of other predictors of incident PAD. |
| first_indexed | 2024-04-10T20:12:51Z |
| format | Article |
| id | doaj.art-db5f32ea1690499abe83c2644f1c77bf |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2025-03-20T19:49:41Z |
| publishDate | 2021-12-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-db5f32ea1690499abe83c2644f1c77bf2024-08-21T05:19:27ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802021-12-01102310.1161/JAHA.121.020841Midlife Cardiorespiratory Fitness and the Development of Peripheral Artery Disease in Later LifeNeil Keshvani0Benjamin Willis1David Leonard2Ang Gao3Laura DeFina4Mary M. McDermott5Jarett D. Berry6Dharam J. Kumbhani7Division of Cardiology University of Texas Southwestern Medical Center Dallas TXCooper Institute Dallas TXCooper Institute Dallas TXCooper Institute Dallas TXCooper Institute Dallas TXNorthwestern University Feinberg School of Medicine Chicago ILDivision of Cardiology University of Texas Southwestern Medical Center Dallas TXDivision of Cardiology University of Texas Southwestern Medical Center Dallas TXBackground Data are sparse on the prospective associations between physical activity and incidence of lower extremity peripheral artery disease (PAD). Methods and Results Linking participant data from the CCLS (Cooper Center Longitudinal Study) to Medicare claims files, we studied 19 023 participants with objectively measured midlife cardiorespiratory fitness through maximal effort on the Balke protocol who survived to receive Medicare coverage between 1999 and 2009. The study aimed to determine the association between midlife cardiorespiratory fitness and incident PAD with proportional hazards intensity models, adjusted for age, sex, body mass index, and other covariates, to PAD failure time data. During 121 288 person‐years of Medicare follow‐up, we observed 805 PAD‐related hospitalizations/procedures among 19 023 participants (21% women, median age 50 years). Lower midlife fitness was associated with a higher rate of incident PAD in patients aged 65 years and older (low fit [quintile 1]: 11.4, moderate fit [quintile 2 to 3]: 7.8, and high fit [quintile 4 to 5]: 5.7 per 1000 person years). After multivariable adjustment for common predictors of incident PAD such as age, body mass index, hypertension, and diabetes, these findings persisted. Lower risk for PAD per greater metabolic equivalent task of fitness was observed (hazard ratio [HR], 0.93 [95% CI, 0.90–0.97]; P<0.001). Among a subset of patients with an additional fitness assessment, each 1 metabolic equivalent task increase from baseline fitness was associated with decreased risk of incident PAD (HR, 0.90 [95% CI, 0.82–0.99]; P=0.03). Conclusions Cardiorespiratory fitness in healthy, middle‐aged adults is associated with lower risk of incident PAD in later life, independent of other predictors of incident PAD.https://www.ahajournals.org/doi/10.1161/JAHA.121.020841cardiorespiratory fitnessmidlifeperipheral artery disease |
| spellingShingle | Neil Keshvani Benjamin Willis David Leonard Ang Gao Laura DeFina Mary M. McDermott Jarett D. Berry Dharam J. Kumbhani Midlife Cardiorespiratory Fitness and the Development of Peripheral Artery Disease in Later Life Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease cardiorespiratory fitness midlife peripheral artery disease |
| title | Midlife Cardiorespiratory Fitness and the Development of Peripheral Artery Disease in Later Life |
| title_full | Midlife Cardiorespiratory Fitness and the Development of Peripheral Artery Disease in Later Life |
| title_fullStr | Midlife Cardiorespiratory Fitness and the Development of Peripheral Artery Disease in Later Life |
| title_full_unstemmed | Midlife Cardiorespiratory Fitness and the Development of Peripheral Artery Disease in Later Life |
| title_short | Midlife Cardiorespiratory Fitness and the Development of Peripheral Artery Disease in Later Life |
| title_sort | midlife cardiorespiratory fitness and the development of peripheral artery disease in later life |
| topic | cardiorespiratory fitness midlife peripheral artery disease |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.121.020841 |
| work_keys_str_mv | AT neilkeshvani midlifecardiorespiratoryfitnessandthedevelopmentofperipheralarterydiseaseinlaterlife AT benjaminwillis midlifecardiorespiratoryfitnessandthedevelopmentofperipheralarterydiseaseinlaterlife AT davidleonard midlifecardiorespiratoryfitnessandthedevelopmentofperipheralarterydiseaseinlaterlife AT anggao midlifecardiorespiratoryfitnessandthedevelopmentofperipheralarterydiseaseinlaterlife AT lauradefina midlifecardiorespiratoryfitnessandthedevelopmentofperipheralarterydiseaseinlaterlife AT marymmcdermott midlifecardiorespiratoryfitnessandthedevelopmentofperipheralarterydiseaseinlaterlife AT jarettdberry midlifecardiorespiratoryfitnessandthedevelopmentofperipheralarterydiseaseinlaterlife AT dharamjkumbhani midlifecardiorespiratoryfitnessandthedevelopmentofperipheralarterydiseaseinlaterlife |