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Dyspnea and All-Cause Mortality: 28-yr Follow-up Study among Adult Twins


Medicine & Science in Sports & Exercise: August 2014 - Volume 46 - Issue 8 - p 1538–1545
doi: 10.1249/MSS.0000000000000255

Introduction Dyspnea has not been widely used as a proxy measure of fitness. Because dyspnea score is simple to obtain, it could be a screening tool for identifying individuals with low fitness and increased mortality risk. The aim was to study how baseline dyspnea, and changes in it, predicts all-cause mortality.

Methods The prospective Finnish Twin Cohort includes all same-sex twin pairs born in Finland before 1958. Dyspnea was measured with a four-question modified Medical Research Council scale. The level and change in dyspnea between 1975 and 1981 were used as the baseline predictors. Altogether, 21,379 twin individuals (8672 complete twin pairs) had answered dyspnea questions in 1975 and 1981. Cox proportional hazards model was used for mortality analysis starting from the 1981 response date until December 31, 2010.

Results Increased mortality was observed among individuals with persistent dyspnea (dyspnea in 1975 and 1981); full covariate adjusted HR of death was 1.41 (95% confidence interval, 1.31–1.52), whereas the HR for dyspnea developers and those with dyspnea remission were 1.16 (1.05–1.25) and 1.07 (0.97–1.19), respectively, compared with asymptomatic individuals. Among healthy subjects at 1981 baseline, the corresponding HR values were 1.34 (1.16–1.54), 1.15 (0.97–1.37), and 1.05 (0.89–1.23). Within-pair analyses of death discordant pairs showed a fully adjusted HR for persistent dyspnea of 1.47 (1.23–1.77) for all twin pairs and 2.64 (1.21–5.74) for healthy monozygotic pairs.

Conclusions Persistent dyspnea predicts increased mortality during a 28-yr follow-up even among individuals without clinically overt disease known to associate with dyspnea. The dyspnea score, which can be easily obtained and correlates with fitness outcomes, could be a screening tool for identifying unfit individuals at an increased mortality risk.

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1Department of Health Sciences, University of Jyväskylä, FINLAND; 2Hjelt Institute and Institute for Molecular Medicine, University of Helsinki, FINLAND; and 3National Institute for Health and Welfare, Helsinki, FINLAND

Address for correspondence: Urho M. Kujala, M.D., Ph.D., Department of Health Sciences, University of Jyväskylä, P.O. Box 35, 40014 Jyväskylä, Finland; E-mail:

Submitted for publication September 2013.

Accepted for publication December 2013.

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© 2014 American College of Sports Medicine