Objective
To determine whether sex modifies the relationship between fitness and mortality.
Patients and Methods
We included 57,284 patients without coronary artery disease or heart failure who completed a routine treadmill exercise test between 1991 and 2009. We determined metabolic equivalents of task (METs) and linked patient records with mortality data via the Social Security Death Index. Multivariable Cox regression was used to determine the association between sex, fitness, and all-cause mortality.
Results
There were 29,470 (51.5%) men and 27,814 (48.6%) women with mean ages of 53 and 54 years, respectively. Overall, men achieved 2 METs higher than women (P<.001). Over a median of 10 years follow-up, there were 6,402 deaths. The mortality rate for men in each MET group was similar to that of women who achieved an average 2.6 METs lower (P=.03). Fitness was inversely associated with mortality in both men (HR 0.84 per 1 MET; 95% CI: 0.83, 0.85) and women (HR 0.83 per 1 MET; 95% CI: 0.81, 0.84). This relationship did not plateau at high or low METs values.
Conclusions
While men demonstrated 2 METs higher than women, their survival was equivalent to women demonstrating 2.6 METs lower. Further, higher METs were associated with lower mortality for both men and women across the range of MET values. These findings are useful for tailoring prognostic information and lifestyle guidance to men and women undergoing stress testing.