How To Tell If You Will Die in The Next Ten Years…

Look into my fuzzy crystal ball… I see a treadmill in your future!

What if there was a test that could tell you if you were at a significant risk for dying in the next ten years? And what if it could alert you so you could take action to prevent that from happening? Would you be interested? Now, before you click on your daily horoscope or call the psychic hotline, or grab another helping of fortune cookies, consider this.

In the March 2, 2015 issue of the journal Mayo Clinic Proceedings cardiologists at the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease analyzed data from 58,000 heart stress tests and came up with a formula that estimates one's risk of dying over a decade based on a person's ability to exercise on a treadmill at an increasing speed and incline.

It’s called the FIT Treadmill Score

The new algorithm, dubbed the FIT Treadmill Score can gauge long-term death risk in anyone based solely on treadmill exercise performance. The score, the research team says, “Could yield valuable clues about a person's health and should be calculated for the millions of patients who undergo cardiac stress testing in the United States each year.”

It is a little different than the commonly recognized exercise stress tests which are used to determine who needs invasive cardiac testing and to inform treatment decisions.

Those exercise-based risk scoring systems already in use are designed to measure short-term risk of dying but do so strictly among patients with established heart disease or overt signs of cardiovascular trouble. Such scores factor in multiple variables and incorporate results from additional tests, including electrocardiograms (EKGs).

Methodology

For the study, the team analyzed information on 58,020 people, ages 18 to 96, from Detroit, Michigan, who underwent standard exercise stress tests between 1991 and 2009 for evaluation of chest pain, shortness of breath, fainting or dizziness. The researchers then tracked how many of the participants within each fitness level died from any cause over the next decade. The results reveal that among people of the same age and gender, fitness level as measured by METs and peak heart rate reached during exercise were the greatest indicators of death risk. Fitness level was the single most powerful predictor of death and survival, even after researchers accounted for other important variables such as diabetes and family history of premature death -- a finding that underscores the profound importance of heart and lung fitness, the investigators say.

The Score

Scores ranged from negative 200 to positive 200, with those above 0 having lower mortality risk and those in the negative range facing highest risk of dying. Patients who scored 100 or higher had a 2 percent risk of dying over the next 10 years, while those with scores between 0 and 100 faced a 3 percent death risk over the next decade. In other words, two of 100 people of the same age and gender with a score of 100 or higher would die over the next decade, compared with three out of 100 for those with a fitness score between 0 and 100. People with scores between negative 100 and 0 had an 11 percent risk of dying in the next 10 years, while those with scores lower than negative 100 had a 38 percent risk of dying.

Here’s how you do it

Based on your performance on the Bruce 7 stage treadmill test you will get a result in metabolic exertion or the metabolic equivalent of task also called “METS”. You then take that number and insert it into the following formula:

(12 x METs) + (% of maximum predicted heart rate) – (4 x age) + 43 if female = YOUR SCORE

*Maximum predicted heart rate is calculated as 220 – age. Heart rate achieved during exercise should be divided by maximum predicted. For example, if you’re 20 years old, your maximum predicted heart rate is 200 (220 – 20). If you achieve 180, you achieved 90 percent of maximum.

It makes sense when you think about it

"The notion that being in good physical shape portends lower death risk is by no means new, but we wanted to quantify that risk precisely by age, gender and fitness level, and do so with an elegantly simple equation that requires no additional fancy testing beyond the standard stress test," says lead investigator Haitham Ahmed, M.D. M.P.H., a cardiology fellow at the Johns Hopkins University School of Medicine.

"Of all the parameters measured, METs and fitness levels were the strongest predictor of whether a person would live or die, even after accounting for family history, disease, and health habits, says Ahmed. “After fitness, age, and gender, almost nothing else mattered or improved survival.”

How come? The answer lies in what we know to be true: the vast power of exercise, according to Dr. Ahmed, “We understand a lot about fitness. And while there is still a lot to learn, we know that usually, those who exercise more often have lower obesity rates, lower blood pressure, lower risk of diabetes, a reduced risk of blood clotting, reduced inflammation, and lower levels of bad cholesterol.”

How to go about this

First, go see your primary healthcare provider. Discuss this test in particular. Ask if you are healthy enough to do a Bruce 7 stage treadmill evaluation. If the answer is yes, ask your provider to write a prescription for the test so it is covered by your healthcare plan.

Then prepare to… Take your mark… Get set… And GO!

Oh and one more thing since you will be calculating your own score, if you have a math-o-phobe in your house and have heard, “When will I ever have to use math? I’m going to be a (insert ballet dancer, existential elephant painter, celestial omnibus driver or other)” you can now point to this passage as a rebuttal.

As Always...

Be Well,

Matthew Minson, M.D.

For more information about the research, or the center mentioned, contact:

Media Contact

Ekaterina Pesheva epeshev1@jhmi.edu 410-502-9433 @HopkinsMedicine

http://www.hopkinsmedicine.org