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Heartbeat: Is biologic age best defined by exercise capacity?
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  1. Catherine M Otto
  1. Correspondence to Professor Catherine M Otto, Division of Cardiology, University of Washington, Seattle, WA 98195, USA; cmotto@u.washington.edu

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Currently, primary prevention of cardiovascular (CV) disease is targeted towards patients at higher risk of adverse events based on scores derived from a combination of clinical factors such as age, sex, hypertension, diabetes, smoking, cholesterol levels and other co-morbidites. The concept of biologic age as an approach to risk stratification was first proposed based on anatomic evidence of subclinical coronary artery disease in asymptomatic patients. The hypothesis that anatomic measures of vascular disease better reflect the patient's biologic, rather than chronologic, age is supported by the additive predictive value of coronary calcium scores. However, the clinical utility of vascular imaging for primary prevention remains controversial. In addition, focusing on vascular anatomy alone may not fully describe the degree of vascular disease. Little attention has been directed to physiologic measures of biologic age as predictors of CV outcome.

In this issue of Heart, the relationship between exercise capacity and CV outcomes was assessed in a retrospective cohort study of over 57 thousand adults (without known coronary artery disease or heart failure) who underwent exercise stress testing at a single institution over an 18 year period (see page 431). Although exercise capacity decreased with age as expected, higher exercise capacity was associated with greater survival in all age groups based on endpoints of all cause mortality at 10 years (n=6356) and myocardial infarction (n=1646) at 5 years follow-up (figure 1). When exercise capacity was used to define biologic age based on linear parametric models for mortality risk, variation by up to 3 decades was seen within each age decile. The authors propose that “biologic age may be a useful clinical tool for facilitating patient discussion regarding the impact of exercise capacity on long-term …

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