Midlife Cardiorespiratory Fitness and the Development of Peripheral Artery Disease in Later Life

Abstract

Background Data are sparse on the prospective associations between physical activity and incidence of lower extremity peripheral artery disease (PAD). Methods and Results Linking participant data from the CCLS (Cooper Center Longitudinal Study) to Medicare claims files, we studied 19 023 participants with objectively measured midlife cardiorespiratory fitness through maximal effort on the Balke protocol who survived to receive Medicare coverage between 1999 and 2009. The study aimed to determine the association between midlife cardiorespiratory fitness and incident PAD with proportional hazards intensity models, adjusted for age, sex, body mass index, and other covariates, to PAD failure time data. During 121 288 person-years of Medicare follow-up, we observed 805 PAD-related hospitalizations/procedures among 19 023 participants (21% women, median age 50 years). Lower midlife fitness was associated with a higher rate of incident PAD in patients aged 65 years and older (low fit [quintile 1]: 11.4, moderate fit [quintile 2 to 3]: 7.8, and high fit [quintile 4 to 5]: 5.7 per 1000 person years). After multivariable adjustment for common predictors of incident PAD such as age, body mass index, hypertension, and diabetes, these findings persisted. Lower risk for PAD per greater metabolic equivalent task of fitness was observed (hazard ratio [HR], 0.93 [95% CI, 0.90-0.97]; P<0.001). Among a subset of patients with an additional fitness assessment, each 1 metabolic equivalent task increase from baseline fitness was associated with decreased risk of incident PAD (HR, 0.90 [95% CI, 0.82-0.99]; P=0.03). Conclusions Cardiorespiratory fitness in healthy, middle-aged adults is associated with lower risk of incident PAD in later life, independent of other predictors of incident PAD.

Keywords: cardiorespiratory fitness; midlife; peripheral artery disease.

Figure 1. Relationship between midlife cardiorespiratory fitness and incidence of peripheral artery disease (PAD) for men and women (A) and adjusted association between cardiorespiratory fitness and PAD (B).

Incidence rates in (A) adjusted for age, whereas associations in (B) were adjusted for body mass index, age, sex, systolic blood pressure, diabetes, cholesterol, and smoking. HR indicates hazard ratio; and MET, metabolic equivalent task. *Modeled separately with METs achieved as a continuous variable.

Figure 2. Population attributable risk of smoking and low fitness to the incidence of peripheral artery disease.

BMI indicates body mass index.