Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
In Reply: We agree with Drs Tosiello and Reddy
about the importance of assessing physical activity as part of a comprehensive
approach to cardiovascular risk stratification. Previous studies have clearly
demonstrated a lower incidence of cardiovascular disease in individuals who
were more physically active.1,2 In
our study, regular exercise was defined as self-reported regular participation
in strenuous exercise or hard physical labor, a very insensitive and imprecise
measure. In univariable Cox logistic regression analysis, regular exercise
was associated with a nonsignificantly lower risk of cardiovascular death
(unadjusted hazard ratio, 0.75; 95% confidence interval, 0.44-1.28). However,
after adjusting for other cardiovascular risk factors, there was no association
with either cardiovascular or all-cause death, and hence it was not included
in the final model. Thus, the simple question used to assess regular exercise
in these asymptomatic women was not very useful. We do not know if a more
complete activity questionnaire would have the predictive value of the objective
and standardized direct measure of fitness obtained from treadmill testing
in this population.
Mora S, Redberg RF, Sharrett AR, Blumenthal RS. Level of Exercise and Risk of Cardiovascular Disease—Reply. JAMA. 2004;291(2):183. doi:10.1001/jama.291.2.183-b
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