title: Influences of cardiorespiratory fitness and other precursors on cardiovascular disease and all-cause mortality in men and women.
abstract: OBJECTIVE
  To quantify the relation of cardiorespiratory fitness to cardiovascular disease (CVD) mortality and to all-cause mortality within strata of other personal characteristics that predispose to early mortality. DESIGN--Observational cohort study. We calculated CVD and all-cause death rates for low (least fit 20%), moderate (next 40%), and high (most fit 40%) fitness categories by strata of smoking habit, cholesterol level, blood pressure, and health status.
  
  
  METHODS
  Preventive medicine clinic.
  
  
  METHODS
  Participants were 25341 men and 7080 women who completed preventive medical examinations, including a maximal exercise test.
  
  
  METHODS
  Cardiovascular disease and all-cause mortality.
  
  
  RESULTS
  There were 601 deaths during 211996 man-years of follow-up, and 89 deaths during 52982 woman-years of follow-up. Independent predictors of mortality among men, with adjusted relative risks (RRs) and 95% confidence intervals (CIs), were low fitness (RR, 1.52;95% CI, 1.28-1.82), smoking (RR, 1.65; 95% CI, 1.39-1.97), abnormal electrocardiogram (RR, 1.64;95% CI, 1.34-2.01), chronic illness (RR, 1.63;95% CI, 1.37-1.95), increased cholesterol level (RR, 1.34; 95% CI, 1.13-1.59), and elevated systolic blood pressure (RR, 1.34; 95% CI, 1.13-1.59). The only statistically significant independent predictors of mortality in women were low fitness (RR, 2.10; 95% Cl, 1.36-3.21) and smoking (RR, 1.99; 95% Cl, 1.25-3.17). Inverse gradients were seen for mortality across fitness categories within strata of other mortality predictors for both sexes. Fit persons with any combination of smoking, elevated blood pressure, or elevated cholesterol level had lower adjusted death rates than low-fit persons with none of these characteristics.
  
  
  CONCLUSIONS
  Low fitness is an important precursor of mortality. The protective effect of fitness held for smokers and nonsmokers, those with and without elevated cholesterol levels or elevated blood pressure, and unhealthy and healthy persons. Moderate fitness seems to protect against the influence of these other predictors on mortality. Physicians should encourage sedentary patients to become physically active and thereby reduce the risk of premature mortality.
authors.affiliation: Cooper Institute for Aerobics Research, Dallas, Tex 75230, USA. steve0704@aol.com
authors.forename: S N
authors.initials: SN
authors.lastname: Blair
authors.forename: J B
authors.initials: JB
authors.lastname: Kampert
authors.forename: H W
authors.initials: HW
authors.lastname: Kohl
authors.forename: C E
authors.initials: CE
authors.lastname: Barlow
authors.forename: C A
authors.initials: CA
authors.lastname: Macera
authors.forename: R S
authors.initials: RS
authors.lastname: Paffenbarger
authors.forename: L W
authors.initials: LW
authors.lastname: Gibbons
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000401:mortality*; D002423:Cause of Death; D016001:Confidence Intervals; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016013:Likelihood Functions; D008297:Male; D008875:Middle Aged; D010808:Physical Examination; D010809:Physical Fitness; D015985:Precipitating Factors; D016016:Proportional Hazards Models; D012044:Regression Analysis; D012307:Risk Factors