title: Cardiorespiratory fitness attenuates risk for major adverse cardiac events in hyperlipidemic men and women independent of statin therapy: The Henry Ford ExercIse Testing Project.
abstract: OBJECTIVE
  We sought to evaluate the effect of cardiorespiratory fitness (CRF) in predicting mortality, myocardial infarction (MI), and revascularization in patients with hyperlipidemia after stratification by gender and statin therapy.
  
  
  RESULTS
  This retrospective cohort study included 33,204 patients with hyperlipidemia (57 ± 12 years old, 56% men, 25% black) who underwent physician-referred treadmill stress testing at the Henry Ford Health System from 1991 to 2009. Patients were stratified by gender, baseline statin therapy, and estimated metabolic equivalents from stress testing. We computed hazard ratios using Cox regression models after adjusting for demographics, cardiac risk factors, comorbidities, pertinent medications, interaction terms, and indication for stress testing.
  
  
  RESULTS
  There were 4,851 deaths, 1,962 MIs, and 2,686 revascularizations over a median follow-up of 10.3 years. In men and women not on statin therapy and men and women on statin therapy, each 1-metabolic equivalent increment in CRF was associated with hazard ratios of 0.86 (95% CI 0.85-0.88), 0.83 (95% CI 0.81-0.85), 0.85 (95% CI 0.83-0.87), and 0.84 (95% CI 0.81-0.87) for mortality; 0.93 (95% CI 0.90-0.96), 0.87 (95% CI 0.83-0.91), 0.89 (95% CI 0.86-0.92), and 0.90 (95% CI 0.86-0.95) for MI; and 0.91 (95% CI 0.88-0.93), 0.87 (95% CI 0.83-0.91), 0.89 (95% CI 0.87-0.92), and 0.90 (95% CI 0.86-0.94) for revascularization, respectively. No significant interactions were observed between CRF and statin therapy (P > .23).
  
  
  CONCLUSIONS
  Higher CRF attenuated risk for mortality, MI, and revascularization independent of gender and statin therapy in patients with hyperlipidemia. These results reinforce the prognostic value of CRF and support greater promotion of CRF in this patient population.
authors: Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD.
authors: Rupert K
authors: RK
authors: Hung
authors: Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD; King Abdul-Aziz Cardiac Center, Riyadh, Saudi Arabia.
authors: Mouaz H
authors: MH
authors: Al-Mallah
authors: Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD.
authors: Mohamud A
authors: MA
authors: Qadi
authors: Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD; University of Miami Miller School of Medicine, Miami, FL.
authors: Gabriel E
authors: GE
authors: Shaya
authors: Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD.
authors: Roger S
authors: RS
authors: Blumenthal
authors: Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD; Baptist Health South Florida, Miami, FL.
authors: Khurram
authors: K
authors: Nasir
authors: Henry Ford Health System, Detroit, MI.
authors: Clinton A
authors: CA
authors: Brawner
authors: Henry Ford Health System, Detroit, MI.
authors: Steven J
authors: SJ
authors: Keteyian
authors: Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD. Electronic address: mblaha1@jhmi.edu.
authors: Michael J
authors: MJ
authors: Blaha
mesh_terms: D005080:Exercise Test / Q000379:methods*; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D006949:Hyperlipidemias / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D010809:Physical Fitness; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014481:United States / Q000453:epidemiology
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors