title: Association of Fitness in Young Adulthood With Survival and Cardiovascular Risk: The Coronary Artery Risk Development in Young Adults (CARDIA) Study.
abstract: OBJECTIVE
  Although cardiorespiratory fitness (CRF) is prognostic in older adults, the effect of CRF during early adulthood on long-term cardiovascular structure, function, and prognosis is less clear.
  
  
  OBJECTIVE
  To examine whether CRF in young adults is associated with long-term clinical outcome and subclinical cardiovascular disease (CVD).
  
  
  METHODS
  Prospective study of 4872 US adults aged 18 to 30 years who underwent treadmill exercise testing at a baseline study visit from March 25, 1985, to June 7, 1986, and 2472 individuals who underwent a second treadmill test 7 years later. Median follow-up was 26.9 years, with assessment of obesity, left ventricular mass and strain, coronary artery calcification (CAC), and vital status and incident CVD. Follow-up was complete on August 31, 2011, and data were analyzed from recruitment through the end of follow-up.
  
  
  METHODS
  The presence of CAC was assessed by computed tomography at years 15 (2000-2001), 20 (2005-2006), and 25 (2010-2011), and left ventricular mass was assessed at years 5 (1990-1991) and 25 (with global longitudinal strain). Incident CVD and all-cause mortality were adjudicated.
  
  
  RESULTS
  Of the 4872 individuals, 273 (5.6%) died and 193 (4.0%) experienced CVD events during follow-up. After comprehensive adjustment, each additional minute of baseline exercise test duration was associated with a 15% lower hazard of death (hazard ratio [HR], 0.85; 95% CI, 0.80-0.91; P < .001) and a 12% lower hazard of CVD (HR, 0.88; 95% CI, 0.81-0.96; P = .002). Higher levels of baseline CRF were associated with significantly lower left ventricular mass index (β = -0.24; 95% CI, -0.45 to -0.03; P = .02) and significantly better lobal longitudinal strain (β = -0.09; 95% CI, -0.14 to -0.05; P < .001) at year 25. Fitness was not associated with CAC. A 1-minute reduction in fitness by year 7 was associated with 21% and 20% increased hazards of death (HR, 1.21; 95% CI, 1.07-1.37; P = .002) and CVD (HR, 1.20; 95% CI, 1.06-1.37; P = .006), respectively, along with a more impaired strain (β = 0.15; 95% CI, 0.08-0.23; P < .001). No association between change in fitness and CAC was found.
  
  
  CONCLUSIONS
  Higher levels of fitness at baseline and improvement in fitness early in adulthood are favorably associated with lower risks for CVD and mortality. Fitness and changes in fitness are associated with myocardial hypertrophy and dysfunction but not CAC. Regular efforts to ascertain and improve CRF in young adulthood may play a critical role in promoting cardiovascular health and interrupting early CVD pathogenesis.
authors.affiliation: Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: Ravi V
authors.initials: RV
authors.lastname: Shah
authors.affiliation: Cardiovascular Medicine Division, Department of Medicine, University of Michigan, Ann Arbor3Nuclear Medicine Division, Department of Radiology, University of Michigan, Ann Arbor.
authors.forename: Venkatesh L
authors.initials: VL
authors.lastname: Murthy
authors.affiliation: Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Colangelo
authors.affiliation: Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland.
authors.forename: Jared
authors.initials: J
authors.lastname: Reis
authors.affiliation: Department of Medicine and Cardiology, Heart and Vascular Institute, Johns Hopkins Medical Institutions, The Johns Hopkins University, Baltimore, Maryland.
authors.forename: Bharath Ambale
authors.initials: BA
authors.lastname: Venkatesh
authors.affiliation: Department of Medicine and Cardiology, Heart and Vascular Institute, Johns Hopkins Medical Institutions, The Johns Hopkins University, Baltimore, Maryland.
authors.forename: Ravi
authors.initials: R
authors.lastname: Sharma
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Rhode Island Hospital, Brown University, Providence, Rhode Island.
authors.forename: Siddique A
authors.initials: SA
authors.lastname: Abbasi
authors.affiliation: Department of Epidemiology, Colorado School of Public Health, Aurora.
authors.forename: David C
authors.initials: DC
authors.lastname: Goff
authors.affiliation: Department of Epidemiology, Vanderbilt University, Nashville, Tennessee.
authors.forename: J Jeffrey
authors.initials: JJ
authors.lastname: Carr
authors.affiliation: Department of Cardiology, Kaiser Permanente Northern California, Oakland11Department of Medicine, University of California, San Francisco.
authors.forename: Jamal S
authors.initials: JS
authors.lastname: Rana
authors.affiliation: Department of Epidemiology, Vanderbilt University, Nashville, Tennessee.
authors.forename: James G
authors.initials: JG
authors.lastname: Terry
authors.affiliation: Human Genomics Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana.
authors.forename: Claude
authors.initials: C
authors.lastname: Bouchard
authors.affiliation: Human Genomics Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Sarzynski
authors.affiliation: Department of Medicine, Massachusetts General Hospital, Boston.
authors.forename: Aaron
authors.initials: A
authors.lastname: Eisman
authors.affiliation: Department of Medicine, Massachusetts General Hospital, Boston.
authors.forename: Tomas
authors.initials: T
authors.lastname: Neilan
authors.affiliation: Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: Saumya
authors.initials: S
authors.lastname: Das
authors.affiliation: Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts15Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Michael
authors.initials: M
authors.lastname: Jerosch-Herold
authors.affiliation: Division of Preventative Medicine, Department of Medicine, University of Alabama at Birmingham.
authors.forename: Cora E
authors.initials: CE
authors.lastname: Lewis
authors.affiliation: Department of Preventative Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Mercedes
authors.initials: M
authors.lastname: Carnethon
authors.affiliation: Human Genomics Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana.
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Lewis
authors.affiliation: Department of Medicine and Cardiology, Heart and Vascular Institute, Johns Hopkins Medical Institutions, The Johns Hopkins University, Baltimore, Maryland.
authors.forename: Joao A C
authors.initials: JA
authors.lastname: Lima
mesh_terms: D000293:Adolescent; D000328:Adult; D058070:Asymptomatic Diseases; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000453:epidemiology*; D005080:Exercise Test; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000453:epidemiology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009765:Obesity / Q000453:epidemiology*; D010809:Physical Fitness; D016016:Proportional Hazards Models; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D014481:United States / Q000453:epidemiology; D061205:Vascular Calcification / Q000000981:diagnostic imaging / Q000453:epidemiology*; D055815:Young Adult