Exercise capacity as an independent risk factor for adverse cardiovascular outcomes among nondiabetic and diabetic patients.
BACKGROUND
To investigate if decreased exercise capacity is an independent risk factor for major adverse cardiovascular events (MACE) in diabetics and nondiabetics.


METHODS
The association of decreased exercise capacity (EC) during a treadmill exercise sestamibi stress test with MACE was investigated in 490 nondiabetics and 404 diabetics. Mean follow-up was 53 months.


RESULTS
Nondiabetics with a predicted EC < 85% had a higher prevalence of myocardial ischemia (34% vs. 19%, p = 0.0002), 2- or 3-vessel obstructive coronary artery disease (CAD) (31% vs. 13%, p = 0.016), myocardial infarction (MI) (17% vs. 7%, p = 0.0005), stroke (8% vs. 2%, p = 0.002), death (11% vs. 3%, p = 0.0002), and MI or stroke or death at follow-up (32% vs. 11%, p < 0.001) compared to nondiabetics with a predicted EC ≥ 85%. Diabetics with a predicted EC < 85% had a higher prevalence of myocardial ischemia (48% vs. 32%, p = 0.0009), 2- or 3-vessel obstructive CAD (54% vs. 28%, p = 0.001), MI (32% vs. 14%, p < 0.001), stroke (22% vs. 6%, p < 0.001), death (17% vs. 9%, p = 0.031), and MI or stroke or death at follow-up (65% vs. 27%, p < 0.001). Stepwise Cox regression analysis showed decreased EC was an independent and significant risk factor for MACE among nondiabetics (hazard ratio 3.3, p < 0.0001) and diabetics (hazard ratio 2.7, p < 0.0001).


CONCLUSIONS
Diabetics and nondiabetics with decreased EC were at increased risk for MACE with nondiabetics and decreased EC at similar risk as diabetics with normal EC.
Department of Medicine, Columbia University Medical Center Harlem Hospital Center, New York, USA.
Bredy
B
Pierre-Louis
Massachusetts General Hospital Harvard Medical School, Boston, USA.
Achuta K
AK
Guddati
Department of Medicine, Columbia University Medical Center Harlem Hospital Center, New York, USA.
Muhammed
M
Khyzar Hayat Syed
Department of Medicine, Columbia University Medical Center Harlem Hospital Center, New York, USA.
Vanessa E
VE
Gorospe
Department of Medicine, Columbia University Medical Center Harlem Hospital Center, New York, USA.
Mark
M
Manguerra
Department of Medicine, Columbia University Medical Center Harlem Hospital Center, New York, USA.
Chaitali
C
Bagchi
Westchester Medical Center/New York Medical College, Valhalla, New York, USA.
Wilbert S
WS
Aronow
Department of Clinical Sciences, University of Texas Southwestern Medical School, Dallas, USA.
Chul
C
Ahn
diabetes; exercise capacity; major adverse cardiac events