Low cardiorespiratory fitness and coronary artery calcification: Complementary cardiovascular risk predictors in asymptomatic type 2 diabetics

Predicting cardiovascular events … How FIT is our crystal ball?

“…In summary, we commend Zafrir and colleagues [13] for their contribution to the literature on the important link between CRF and outcomes. Regardless of the availability of sufficient data on CRF to guide evidence-based ASCVD risk estimates, we believe it is prudent to use CRF to refine risk assessment and guide clinical decisions.…”

“…In the current issue of Atherosclerosis, Zafrir and colleagues [13] build on prior studies that support the important relationship between CRF and risk of morbidity and mortality. In a prospective cohort study of asymptomatic patients with type 2 diabetes mellitus (DM) and no history of CHD (n ¼ 600; 55 to 74 y; 53% female), they evaluated the incremental prognostic value of low CRF on the relationship between CAC and risk of a composite outcome that included all-cause mortality, myocardial infarction, and stroke.…”

“…After adjustment for traditional risk factors, low CRF was significantly associated with a 2.5-fold greater risk for the composite outcome. In the presence of CAC score and/or the United Kingdom Prospective Diabetes Study risk score, low CRF continued to be significantly associated with more than twice the risk for the composite outcome [13].…”

“…Moreover, individuals with a CAC score <10 represent a very low risk subgroup of patients with type 2 DM [16]. In the study by Zafrir and colleagues [13] low CRF further stratified risk among patients with type 2 DM and either a CAC score <10 or !10 with a net reclassification index of 45%.…”

The prognostic value of exercise testing: Exercise capacity, hemodynamic response, and cardio-metabolic risk factors

“…Cardiorespiratory fitness, based on percentage of predicted METs achieved during maximal exercise testing, was shown to provide additive prognostic information in type 2 diabetics, beyond that obtained from standard risk scores and coronary artery calcium scoring. 5 Similarly, the addition of exercise capacity to the systematic coronary risk evaluation (SCORE) risk model was shown to significantly increase the accuracy of prediction of allcause mortality among asymptomatic healthy individuals. 6 However, despite its well-established prognostic value and the ability to reclassify risk, cardiorespiratory fitness is not incorporated routinely in risk prediction models and assessment tools.…”