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Higher Fitness in Patients with Family History of CHD

Am J Med; ePub 2016 Oct 14; Al Rifai, Patel, et al

Publish date:

Regardless of family history status, higher cardiorespiratory fitness is strongly protective in all patients, according to a recent study. The Henry Ford Exercise Testing (FIT) Project included 57,999 patients (53±12 years, 49% female, 29% black) with cardiorespiratory fitness expressed in metabolic equivalents of task based on exercise stress testing. Family history was determined as self-reported coronary heart disease (CHD) in a first-degree relative at any age. Researchers found:

  • 51% of patients reported a positive family history.
  • Each 1 unit MET increase was associated with lower incident CHD and mortality risk regardless of family history status.
  • Each 1 unit MET increase in exercise capacity, the hazard ratio for family history negative and family history positive individuals was: 0.87 and 0.87 for incident CHD, and 0.83 and 0.83 for mortality, respectively.
  • No significant interaction between family history and categorical cardiorespiratory fitness, age, or sex, was observed.

Citation:

Al Rifai M, Patel J, Hung RK, et al. Higher fitness is strongly protective in patients with family history of heart disease: The FIT Project. [Published online ahead of print October 14, 2016]. Am J Med. doi:10.1016/j.amjmed.2016.09.026.

Commentary:

A family history of coronary artery disease (CAD) is a strong risk factor for the development of coronary disease and cardiovascular mortality.1 It is well demonstrated that exercise and fitness protect against the development of CAD in unselected populations as well as those with risk factors. The current analysis extends this result to show that it applies as well to people with a family history of CAD. In individuals with a positive family history of CAD, each 1-MET increase in cardiorespiratory fitness was associated with a 13% and 17% reduction in coronary heart disease and mortality risk, respectively. This is an impressive result, and further confirms that exercise acts essentially as a “negative risk-factor,” substantially decreasing the risk increase associated with a family history of CAD. —Neil Skolnik, MD

  1. Lloyd-Jones DM, Nam B-H, D’Agostino RB, et al. Parental cardiovascular disease as a risk factor for cardiovascular disease in middle-aged adults: a prospective study of parents and offspring. JAMA. 2004;291: 2204–11.

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