title: Prediction of 30-year risk for cardiovascular mortality by fitness and risk factor levels: the Cooper Center Longitudinal Study.
abstract: BACKGROUND
  Fitness and traditional risk factors have well-known associations with cardiovascular disease (CVD) death in both short-term (10 years) and across the remaining lifespan. However, currently available short-term and long-term risk prediction tools do not incorporate measured fitness.
  
  
  RESULTS
  We included 16 533 participants from the Cooper Center Longitudinal Study (CCLS) without prior CVD. Fitness was measured using the Balke protocol. Sex-specific fitness levels were derived from the Balke treadmill times and categorized into low, intermediate, and high fit according to age- and sex-specific treadmill times. Sex-specific 30-year risk estimates for CVD death adjusted for competing risk of non-CVD death were estimated using the cause-specific hazards model and included age, body mass index, systolic blood pressure, fitness, diabetes mellitus, total cholesterol, and smoking. During a median follow-up period of 28 years, there were 1123 CVD deaths. The 30-year risk estimates for CVD mortality derived from the cause-specific hazards model demonstrated overall good calibration (Nam-D'Agostino χ(2) [men, P=0.286; women, P=0.664] and discrimination (c statistic; men, 0.81 [0.80-0.82] and women, 0.86 [0.82-0.91]). Across all risk factor strata, the presence of low fitness was associated with a greater 30-year risk for CVD death.
  
  
  CONCLUSIONS
  Fitness represents an important additional covariate in 30-year risk prediction functions that may serve as a useful tool in clinical practice.
authors.affiliation: From the Division of Cardiology, Department of Internal Medicine (C.D.W., S.D., J.A.d.L., J.D.B.) and Reynolds Cardiovascular Clinical Research Center (C.R.A.), University of Texas Southwestern Medical Center, Dallas; and Cooper Institute, Dallas, TX (B.L.W.).
authors.forename: Chanaka D
authors.initials: CD
authors.lastname: Wickramasinghe
authors.affiliation: From the Division of Cardiology, Department of Internal Medicine (C.D.W., S.D., J.A.d.L., J.D.B.) and Reynolds Cardiovascular Clinical Research Center (C.R.A.), University of Texas Southwestern Medical Center, Dallas; and Cooper Institute, Dallas, TX (B.L.W.).
authors.forename: Colby R
authors.initials: CR
authors.lastname: Ayers
authors.affiliation: From the Division of Cardiology, Department of Internal Medicine (C.D.W., S.D., J.A.d.L., J.D.B.) and Reynolds Cardiovascular Clinical Research Center (C.R.A.), University of Texas Southwestern Medical Center, Dallas; and Cooper Institute, Dallas, TX (B.L.W.).
authors.forename: Sandeep
authors.initials: S
authors.lastname: Das
authors.affiliation: From the Division of Cardiology, Department of Internal Medicine (C.D.W., S.D., J.A.d.L., J.D.B.) and Reynolds Cardiovascular Clinical Research Center (C.R.A.), University of Texas Southwestern Medical Center, Dallas; and Cooper Institute, Dallas, TX (B.L.W.).
authors.forename: James A
authors.initials: JA
authors.lastname: de Lemos
authors.affiliation: From the Division of Cardiology, Department of Internal Medicine (C.D.W., S.D., J.A.d.L., J.D.B.) and Reynolds Cardiovascular Clinical Research Center (C.R.A.), University of Texas Southwestern Medical Center, Dallas; and Cooper Institute, Dallas, TX (B.L.W.).
authors.forename: Benjamin L
authors.initials: BL
authors.lastname: Willis
authors.affiliation: From the Division of Cardiology, Department of Internal Medicine (C.D.W., S.D., J.A.d.L., J.D.B.) and Reynolds Cardiovascular Clinical Research Center (C.R.A.), University of Texas Southwestern Medical Center, Dallas; and Cooper Institute, Dallas, TX (B.L.W.). jarett.berry@utsouthwestern.edu.
authors.forename: Jarett D
authors.initials: JD
authors.lastname: Berry
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000401:mortality* / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D008297:Male; D008875:Middle Aged; D010809:Physical Fitness; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013781:Texas / Q000453:epidemiology; D055815:Young Adult
keywords: cardiovascular diseases; mortality; risk factors