title: Self-reported cardiorespiratory fitness: prediction and classification of risk of cardiovascular disease mortality and longevity--a prospective investigation in the Copenhagen City Heart Study.
abstract: BACKGROUND
  The predictive value and improved risk classification of self-reported cardiorespiratory fitness (SRCF), when added to traditional risk factors on cardiovascular disease (CVD) and longevity, are unknown.
  
  
  RESULTS
  A total of 3843 males and 5093 females from the Copenhagen City Heart Study without CVD in 1991-1994 were analyzed using multivariate Cox hazards regression to assess the predictive value and survival benefit for CVD and all-cause mortality from SRCF. The category-free net reclassification improvement from SRCF was calculated at 15-year follow-up on CVD and all-cause mortality. Overall, 1693 individuals died from CVD. In the fully adjusted Cox model, those reporting the same (hazard ratio [HR], 1.17; 95% confidence interval [CI], 1.04 to 1.32) and lower (HR, 1.91; 95% CI, 1.62 to 2.24) SRCF than peers had an increased risk of CVD mortality, compared with individuals with higher SRCF. Compared with individuals with higher SRCF, those with the same and lower SRCF had 1.8 (95% CI, 1.0 to 2.5) and 5.1 (95% CI, 4.1 to 6.2) years lower life expectancy, respectively. Individuals with lower SRCF had a significantly increased risk of CVD mortality, compared with individuals with higher SRCF, within each strata of leisure time physical activity and self-rated health, and SRCF significantly predicted CVD mortality independently of self-rated health and walking pace. A net reclassification improvement of 30.5% (95% CI, 22.1% to 38.9%) for CVD mortality was found when adding SRCF to traditional risk factors. Comparable findings were found for all-cause mortality.
  
  
  CONCLUSIONS
  SRCF has independent predictive value, is related to a considerable survival benefit, and improves risk classification when added to traditional risk factors of CVD and all-cause mortality. SRCF might prove useful in improved risk stratification in primary prevention.
authors: The National Research Center for the Working Environment, Copenhagen, Denmark (A.H., O.S.M.).
authors: Andreas
authors: A
authors: Holtermann
authors: The Copenhagen City Heart Study, Frederiksberg Hospital, Copenhagen, Denmark (J.L.M., E.P., P.S.).
authors: Jacob Louis
authors: JL
authors: Marott
authors: The Copenhagen Male Study, Epidemiological Research Unit, Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, Copenhagen, Denmark (F.G., O.S.M.).
authors: Finn
authors: F
authors: Gyntelberg
authors: Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark (K.).
authors: Karen
authors: K
authors: Søgaard
authors: The National Research Center for the Working Environment, Copenhagen, Denmark (A.H., O.S.M.) The Copenhagen Male Study, Epidemiological Research Unit, Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, Copenhagen, Denmark (F.G., O.S.M.).
authors: Ole Steen
authors: OS
authors: Mortensen
authors: The Copenhagen City Heart Study, Frederiksberg Hospital, Copenhagen, Denmark (J.L.M., E.P., P.S.) Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (E.P.).
authors: Eva
authors: E
authors: Prescott
authors: The Copenhagen City Heart Study, Frederiksberg Hospital, Copenhagen, Denmark (J.L.M., E.P., P.S.).
authors: Peter
authors: P
authors: Schnohr
mesh_terms: D000328:Adult; D000367:Age Factors; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D002423:Cause of Death; D015331:Cohort Studies; D003718:Denmark; D005260:Female; D006801:Humans; D008136:Longevity; D008297:Male; D008875:Middle Aged; D010809:Physical Fitness / Q000502:physiology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D057566:Self Report; D012737:Sex Factors; D014505:Urban Population
keywords: cardiovascular mortality; net reclassification improvement; self‐reported fitness
references: JAMA. 1989 Nov 3;262(17):2395-401
references: 2795824
references: Stat Med. 2008 Jan 30;27(2):157-72; discussion 207-12
references: 17569110
references: Stat Med. 2008 Jan 30;27(2):173-81
references: 17671958
references: Ann Intern Med. 2010 Feb 2;152(3):195-6; author reply 196-7
references: 20124243
references: J Phys Act Health. 2014 May;11(4):853-9
references: 23676451
references: Scand J Med Sci Sports. 2013 Dec;23(6):749-57
references: 22417235
references: Circulation. 2011 Apr 5;123(13):1377-83
references: 21422392
references: Stat Med. 2011 Jan 15;30(1):11-21
references: 21204120
references: Stat Med. 2009 Mar 15;28(6):901-16
references: 19156698
references: Dan Med Bull. 2009 Feb;56(1):40-71
references: 19232166
references: J Am Geriatr Soc. 2001 May;49(5):632-8
references: 11380757
references: Am J Prev Med. 2003 May;24(4):316-22
references: 12726869
references: J Chronic Dis. 1982;35(6):437-43
references: 7042727
references: N Engl J Med. 1988 Nov 24;319(21):1379-84
references: 3185648
references: JAMA. 1996 Jul 17;276(3):205-10
references: 8667564
references: J Gen Intern Med. 2006 Mar;21(3):267-75
references: 16336622