title: Higher Fitness Is Strongly Protective in Patients with Family History of Heart Disease: The FIT Project.
abstract: BACKGROUND
  Cardiorespiratory fitness protects against mortality; however, little is known about the benefits of improved fitness in individuals with a family history of coronary heart disease. We studied the association between cardiorespiratory fitness and risk of incident coronary heart disease and all-cause mortality, hypothesizing an inverse relationship similar to individuals without a family history of coronary heart disease.
  
  
  METHODS
  We included 57,999 patients (aged 53 ± 13 years; 49% were female; 29% were black) from the Henry Ford Exercise Testing (FIT) Project. Cardiorespiratory fitness was expressed in metabolic equivalents of task based on exercise stress testing. Family history was determined as self-reported coronary heart disease in a first-degree relative at any age. We used Cox proportional hazards models adjusted for demographics and cardiovascular disease risk factors to examine the association between cardiorespiratory fitness and risk of incident coronary heart disease and mortality over a median (interquartile range) follow-up of 5.5 (5.6) and 10.4 (6.8) years, respectively.
  
  
  RESULTS
  Overall, 51% reported a positive family history. Each 1-unit metabolic equivalent increase was associated with lower incident coronary heart disease and mortality risk regardless of family history status. The hazard ratio and 95% confidence interval for a negative family history and a positive family history were 0.87 (0.84-0.89) and 0.87 (0.85-0.89) for incident coronary heart disease and 0.83 (0.82-0.84) and 0.83 (0.82-0.85) for mortality, respectively. There was no significant interaction between family history and categoric cardiorespiratory fitness, sex, or age (P >.05 for all).
  
  
  CONCLUSIONS
  Higher cardiorespiratory fitness is strongly protective in all patients regardless of family history status, supporting recommendations for regular exercise in those with a family history.
authors.affiliation: The University of Kansas, School of Medicine, Wichita; Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Md.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Al Rifai
authors.affiliation: Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Md; Department of General of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond. Electronic address: jaideep.patel@vcuhealth.org.
authors.forename: Jaideep
authors.initials: J
authors.lastname: Patel
authors.affiliation: Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Md.
authors.forename: Rupert K
authors.initials: RK
authors.lastname: Hung
authors.affiliation: Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Md; Center for Prevention and Wellness, Baptist Health South Florida, Miami, Fla.
authors.forename: Khurram
authors.initials: K
authors.lastname: Nasir
authors.affiliation: Henry Ford Hospital, Detroit, Mich.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Keteyian
authors.affiliation: Henry Ford Hospital, Detroit, Mich.
authors.forename: Clinton A
authors.initials: CA
authors.lastname: Brawner
authors.affiliation: Henry Ford Hospital, Detroit, Mich.
authors.forename: Jonathan K
authors.initials: JK
authors.lastname: Ehrman
authors.affiliation: King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
authors.forename: Sherif
authors.initials: S
authors.lastname: Sakr
authors.affiliation: Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Md.
authors.forename: Roger S
authors.initials: RS
authors.lastname: Blumenthal
authors.affiliation: Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Md.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Blaha
authors.affiliation: Henry Ford Hospital, Detroit, Mich; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; King Abdulaziz Cardiac Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.
authors.forename: Mouaz H
authors.initials: MH
authors.lastname: Al-Mallah
mesh_terms: D003327:Coronary Disease / Q000453:epidemiology* / Q000235:genetics / Q000401:mortality; D005080:Exercise Test; D005190:Family; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000235:genetics / Q000401:mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010809:Physical Fitness; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Ethnic; Exercise capacity; Family history; Mortality; Prevention