Research Article|Articles in Press

A moderate walking test predicts survival in women with cardiovascular disease



      Cardiovascular disease (CVD) is the principal cause of death in US women. Peak oxygen uptake (VO2peak) is strongly related to mortality and CVD. This study aimed to investigate the association between estimated VO2peak, determined using a moderate 1-km walking test (1k-TWT), and all-cause mortality in female patients with stable CVD.


      Of the 482 women comprising in our registry between 1997-2020, we included 430 participants in the analysis (age 67 [34-88] years). A Cox proportional hazard model was used to determine variables significantly associated with mortality. Based on the VO2peak estimated using the 1k-TWT, the sample was subdivided into tertiles, and mortality risk was calculated. The discriminatory accuracy of VO2peak in estimating survival was assessed by receiver-operating-characteristic (ROC) curves. All results were adjusted for demographic and clinical covariates.


      A total of 135 deaths from any cause occurred over a median of 10.4 years (IQR 4.4-16.4), with an average annual mortality of 4.2%. Estimated VO2peak was a stronger predictor of all-cause mortality than demographic and clinical variables (c-statistic 0.767, 95% CI: 0.72-0.81, p<0.0001). The survival rate decreased from the highest tertile of fitness to the lowest. Compared to the lowest group, hazard ratios (95% confidence intervals) for the second and third tertiles were 0.55 (0.37-0.83) and 0.29 (0.16-0.51), respectively (p for trend <0.0001).


      Higher VO2peak levels were associated with a lower risk of all-cause mortality. The indirect estimation of VO2peak using the 1k-TWT is feasible and can be applied for risk stratification among female patients undergoing secondary prevention programs.


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