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CLINICAL RESEARCH

Peak oxygen intake and cardiac mortality in women referred for cardiac rehabilitation

Terence Kavanagh, MD, FACC^*,*, Donald J. Mertens, MD, MSc^*, Larry F. Hamm, PhD^*,||, Joseph Beyene, PhD, Johanna Kennedy, RN^*, Paul Corey, PhD and Roy J. Shephard, MD, PhD

^* Toronto Rehabilitation Institute (formerly Toronto Rehabilitation Centre), Toronto, Canada
Faculty of Medicine, University of Toronto, Toronto, Canada
Faculty of Physical Education and Health, University of Toronto, Toronto, Canada
Department of Public Health Sciences, University of Toronto, Toronto, Canada
^|| George Washington University, Washington, DC, USA

Manuscript received April 21, 2003; revised manuscript received July 7, 2003, accepted July 28, 2003.

^* Reprint requests and correspondence: Dr. Terence Kavanagh, Room 306, Columbus Centre, 901 Lawrence Avenue West, Toronto, Ontario M6A 1C3, Canada
terence.kavanagh{at}utoronto.ca

OBJECTIVES: This study investigated the prognostic importance of measured peak oxygen intake (O_2peak) in women with known coronary heart disease referred for outpatient cardiac rehabilitation.

BACKGROUND: Exercise capacity is a powerful predictor of prognosis in men with known or suspected coronary disease. Similar findings are described in women, but fewer studies have utilized measured O_2peak, the most accurate measure of exercise capacity.

METHODS: A single-center design took data from 2,380 women, age 59.7 ± 9.5 years (1,052 myocardial infarctions, 620 coronary bypass procedures, and 708 with proven ischemic heart disease), who underwent cardiorespiratory exercise testing. They were followed for an average of 6.1 ± 5 years (median 4.5 years, range 0.4 to 25 years) until cardiac and all-cause death.

RESULTS: We recorded 95 cardiac deaths and 209 all-cause deaths. Measured O_2peak was an independent predictor of risk, values 13 ml/kg/min (3.7 multiples of resting metabolic rate) conferring a 50% reduction in cardiac mortality (hazard ratio [HR] 0.5, p = 0.001). Considered as a continuous variable, a 1 ml/kg/min advantage in initial O_2peak was associated with a 10% lower cardiac mortality. Adverse predictors were diabetes (HR 2.73, p = 0.0005) and antiarrhythmic therapy (HR 3.93, p = 0.0001).

CONCLUSIONS: As in men, measured O_2peak is a strong independent predictor of cardiac mortality in women referred for cardiac rehabilitation.

Abbreviations and Acronyms   CABG = coronary artery bypass graft   CHD = coronary heart disease   CI = confidence interval   HR = hazard ratio   IHD = ischemic heart disease   METs = multiples of resting metabolic rate   MI = myocardial infarction   O2peak = peak oxygen intake

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