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Lifetime Risks for Cardiovascular Disease Mortality by Cardiorespiratory Fitness Levels Measured at Ages 45, 55, and 65 Years in Men:: The Cooper Center ...

JD Berry, B Willis, S Gupta, CE Barlow... - Journal of the American ..., 2011 - Elsevier Objectives The purpose of this study was to determine the association between fitness and lifetime risk for cardiovascular disease (CVD). Background Higher levels of traditional risk factors are associated with marked differences in lifetime risks for CVD. However, data are ...

Despite a substantial decline in cardiovascular disease (CVD) death rates over the past 3 decades (1), CVD remains the leading cause of mortality in the United States. Moreover, recent data suggest that unfavorable lifestyle trends promoting weight gain are leading to an increase in some CVD risk factors such as diabetes mellitus, obesity, and metabolic syndrome, which may halt or even reverse the favorable trends in CVD death (1). For example, only 1 in 2 adults achieve recommended moderate or vigorous activity levels in a given week (2). Therefore, more effective public health and clinical strategies are needed to communicate the importance of lifestyle factors such as physical activity in preventing CVD.

Prior research has demonstrated an independent, dose-dependent, inverse association between cardiorespiratory fitness and CVD outcomes among persons with and without CVD at baseline ( [3], [4], [5], [6] and [7]). While the consistency of these data provide support for the protective role of fitness, the reporting of these associations as absolute or relative risk estimates has well-recognized limitations for risk communication strategies ( [8], [9], [10] and [11]). Therefore, national guidelines suggest clinicians consider current risk factor burden within the context of long-term or lifetime risk for CVD ( [12], [13] and [14]).

We and others have reported the association between traditional risk factors (i.e., smoking, diabetes, cholesterol, and blood pressure) and lifetime risks for CVD ( [15], [16] and [17]). However, it is unknown whether a single measurement of fitness in mid-life is associated with lifetime risks for CVD many years later. In addition, the combined effect of fitness and traditional risk factors on lifetime risks for CVD mortality is also unknown.

Therefore, the purpose of the present study was to determine the association between fitness measured at ages 45, 55, and 65 years and the lifetime risks for CVD death using a well-characterized cohort from the CCLS (Cooper Center Longitudinal Study) with objectively measured fitness data. Because of the large sample size and long-term follow-up needed to create lifetime risk estimates, to our knowledge, this cohort represents 1 of the only available datasets to conduct such analyses.

We included 11,049 men who underwent clinical examination at the Cooper Institute in Dallas, Texas, before 1990. Because of the long-term follow-up and large number of events required for lifetime risk analyses, we included men 30 years later particularly among persons with at least 1 risk factor in mid-life. These data emphasize the importance of fitness on long-term cardiovascular health and could be useful for practicing clinicians to facilitate more effective risk communication regarding the health benefits of exercise.