Combined effects of exercise capacity and coronary atherosclerotic burden on all-cause mortality in asymptomatic Koreans.
Both exercise capacity and coronary artery calcium score (CACS) are important prognostic factors in cardiovascular outcome. Yet, whether there is a significant interaction between these two factors in influencing clinical outcome is still uncertain. This study investigated the combined effects of exercise capacity and CACS on all-cause mortality in an asymptomatic population.



From multicenter registry of health screening, a retrospective cohort of 25,972 asymptomatic subjects, who underwent both CACS and treadmill exercise test, was included in the final dataset for analysis. Outcome was defined as all-cause mortality, which was obtained from national mortality registry.



The mean age of study subjects was 53.7 ± 7.7 years and 81.5% of them were males. Median follow-up duration was 5.5 (IQR 3.6-7.5) years and 226 (0.9%) cases of all-cause mortality occurred. In multivariate Cox's proportional hazard model with interaction term, exercise capacity ≥10 METs (HR 0.684, 95% CI 0.483-0.971) and CACS ≥400 (HR 3.328, 95% CI 1.850-5.988) were significant predictors of all-cause mortality. In patients with higher exercise capacity, the effect of high CACS on all-cause mortality was significantly smaller than in those with lower exercise capacity. The HR for all-cause mortality of CACS ≥400, in those with lower exercise capacity, is estimated to be about three times of that in those with higher exercise capacity (HR 3.328 in <10 METs vs. 1.108 in ≥10 METs, p for interaction = 0.024) after adjustment for age, gender, fasting glucose, creatinine, alanine transaminase and albumin.



The effect of high CACS on all-cause mortality is lessened by good exercise capacity in the asymptomatic population. Good physical fitness may reduce the adverse effect of high coronary atherosclerotic burden.
Division of Cardiology, Seoul National University Hospital, Healthcare System Gangnam Center, Seoul National University College of Medicine, Seoul, Republic of Korea. Electronic address: sychoi1119@snuh.org.
Su-Yeon
SY
Choi
Division of Cardiology, Sungkyunkwan University School of Medicine, Heart Stroke & Vascular Institute, Samsung Medical Center, Seoul, Republic of Korea. Electronic address: jdsung@skku.edu.
Jidong
J
Sung
Division of Cardiology, Seoul National University Hospital, Healthcare System Gangnam Center, Seoul National University College of Medicine, Seoul, Republic of Korea. Electronic address: hyoeunmd@gmail.com.
Hyo Eun
HE
Park
Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea. Electronic address: ibanezera@gmail.com.
Donghee
D
Han
Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea. Electronic address: hjchang@yuhs.ac.
Hyuk-Jae
HJ
Chang
D000328:Adult; D000368:Aged; D003324:Coronary Artery Disease / Q000401:mortality / Q000503:physiopathology*; D005080:Exercise Test; D017079:Exercise Tolerance; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010809:Physical Fitness; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries; D056910:Republic of Korea; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D061205:Vascular Calcification / Q000175:diagnosis
All-cause mortality; Coronary atherosclerosis; Exercise capacity