title: Association of Cardiorespiratory Fitness With Coronary Heart Disease in Asymptomatic Men.
abstract: OBJECTIVE
  To examine the association of cardiorespiratory fitness (CRF) with risk of coronary heart disease (CHD) while controlling for an individual's Framingham Risk Score (FRS)-predicted CHD risk.
  
  
  METHODS
  The study included 29,854 men from the Aerobics Center Longitudinal Study, who received a baseline examination from January 1, 1979, to December 31, 2002. Coronary heart disease events included self-reported myocardial infarction or revascularization or CHD death. Multivariable survival analysis investigated the association between CRF, FRS, and CHD. Cardiorespiratory fitness was analyzed as both a continuous and a categorical variable. The population was stratified by "low" and "moderate or high" risk of CHD to test for differences in the FRS stratified by CRF.
  
  
  RESULTS
  Compared with men without incident CHD, men with incident CHD were older (mean age, 51.6 years vs 44.6 years), had lower average maximally achieved fitness (10.9 metabolic equivalent of tasks vs 12.0 metabolic equivalent of tasks [METs]), and were more likely to have moderate or high 10-year CHD risk (P<.001). Cardiorespiratory fitness, defined as maximal METs, exhibited a 20% lower risk of CHD (hazard ratio, 0.80; 95% CI, 0.77-0.83) for each 1-unit MET increase. Among men in the low CRF strata, individuals with moderate or high 10-year CHD risk, according to the FRS, had a higher CHD risk (hazard ratio, 6.55; 95% CI, 3.64-11.82) than men with low CHD risk according to the FRS.
  
  
  CONCLUSIONS
  Clinicians should promote physical activity to improve CRF so as to reduce CHD risk, even to patients with otherwise low CHD risk.
authors.affiliation: Department of Surgery, School of Medicine, Emory University, Atlanta, GA. Electronic address: jennifer.gander@emory.edu.
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Gander
authors.affiliation: Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia.
authors.forename: Xuemei
authors.initials: X
authors.lastname: Sui
authors.affiliation: Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia; South Carolina Statewide Cancer Prevention and Control Program, University of South Carolina, Columbia.
authors.forename: James R
authors.initials: JR
authors.lastname: Hébert
authors.affiliation: Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia.
authors.forename: Linda J
authors.initials: LJ
authors.lastname: Hazlett
authors.affiliation: Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia.
authors.forename: Bo
authors.initials: B
authors.lastname: Cai
authors.affiliation: Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-University of Queensland School of Medicine, New Orleans, LA.
authors.forename: Carl J
authors.initials: CJ
authors.lastname: Lavie
authors.affiliation: Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia; Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia.
authors.forename: Steven N
authors.initials: SN
authors.lastname: Blair
mesh_terms: D000328:Adult; D058070:Asymptomatic Diseases / Q000453:epidemiology; D015992:Body Mass Index; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000453:epidemiology / Q000378:metabolism / Q000503:physiopathology / Q000517:prevention & control; D017079:Exercise Tolerance; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D055686:Metabolic Equivalent; D008875:Middle Aged; D010809:Physical Fitness / Q000502:physiology*; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D014481:United States / Q000453:epidemiology