The joint impact of smoking and exercise capacity on clinical outcomes among women with suspected myocardial ischemia: the WISE study.
BACKGROUND
Although extensive research has been conducted on both smoking and low exercise capacity alone, few studies have examined the joint impact or interaction of these two risk factors. We examined the joint and interactive effects of smoking and self-reported exercise capacity on subsequent clinical events (heart failure, myocardial infarction [MI], stroke, and cardiovascular-related mortality) among women with suspected myocardial ischemia.


METHODS
At baseline (1996-1999), 789 women completed angiographic testing of coronary artery disease (CAD) severity and provided self-report information about their smoking history and exercise capacity as well as demographic and other risk factor data. Incidence of clinical events among the women was tracked for a median of 5.9 years; this analysis was conducted in 2008.


RESULTS
In an adjusted survival analysis, women with a positive smoking history and self-reported low exercise capacity had the greatest risk of experiencing a clinical event (HR = 7.7, 95% CI 2.3, 25.5), followed by women with a positive smoking history and self-reported high exercise capacity (HR = 6.9, 95% CI 2.0, 24.6) and those with a negative smoking history and self-reported low exercise capacity (HR = 4.9, 95% CI 1.5, 15.8), relative to women with a negative smoking history and self-reported high exercise capacity. Additional analyses revealed a significant interaction between smoking history and exercise capacity, such that (1) women with a positive smoking history did not experience an additional significantly greater risk due to low exercise capacity, unlike those with a negative smoking history, and (2) all women experienced a significantly greater risk due to a positive smoking history regardless of their exercise capacity.


CONCLUSIONS
Among women with suspected myocardial ischemia, the combined protective health effects of self-reported high exercise capacity and a negative smoking history remained significant after controlling for preexisting CAD severity and other established risk factors. These findings highlight the importance of studying behavioral risk factors in combination.
Linke
Sarah E
SE
San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California 92120, USA. slinke@ucsd.edu
Rutledge
Thomas
T
Johnson
B Delia
BD
Olson
Marian B
MB
Bittner
Vera
V
Cornell
Carol E
CE
Shaw
Leslee J
LJ
Eteiba
Wafia
W
Parashar
Susmita
S
Sheps
David S
DS
Vido
Diane A
DA
Mulukutla
Suresh
S
Bairey Merz
C Noel
CN
D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D015444:Exercise; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D017202:Myocardial Ischemia; D010809:Physical Fitness; D012307:Risk Factors; D012720:Severity of Illness Index; D012907:Smoking; D016019:Survival Analysis