INFLUENCES OF CARDIORESPIRATORY FITNESS AND OTHER PRECURSORS ON CARDIOVASCULAR-DISEASE AND ALL-CAUSE MORTALITY IN MEN AND WOMEN

Objective.-To quantify the relation of cardiorespiratory fitness to ca rdiovascular disease (CVD) mortality and to all-cause mortality within strata of other personal characteristics that predispose to early mor tality. Design.-Observational cohort study. We calculated CVD and all- cause death rates for low (least fit 20%), moderate (next 40%), and hi gh (most fit 40%) fitness categories by strata of smoking habit, chole sterol level, blood pressure, and health status. Setting.-Preventive m edicine clinic. Study Participants.-Participants were 25 341 men and 7 080 women who completed preventive medical examinations, including a m aximal exercise test. Main Outcome Measures.-Cardiovascular disease an d all-cause mortality. Results.-There were 601 deaths during 211 996 m an-years of follow-up, and 89 deaths during 52 982 woman-years of foll ow-up. Independent predictors of mortality among men, with adjusted re lative risks (RRs) and 95% confidence intervals (Cls), were low fitnes s (RR, 1.52; 95% CI, 1.28-1.82), smoking (RR, 1.65; 95% CI, 1.39-1.97) , abnormal electrocardiogram (RR, 1.64; 95% CI, 1.34-2.01), chronic il lness (RR, 1.63; 95% CI, 1.37-1.95), increased cholesterol level (RR, 1.34; 95% CI, 1.13-1.59), and elevated systolic blood pressure (RR, 1. 34; 95% CI, 1.13-1.59), The only statistically significant independent predictors of mortality in women were low fitness (RR, 2.10; 95% CI, 1.36-3.21) and smoking (RR, 1.99; 95% CI, 1.25-3.17). Inverse gradient s were seen for mortality across fitness categories within strata of o ther mortality predictors for both sexes. Fit persons with any combina tion of smoking, elevated blood pressure, or elevated cholesterol leve l had lower adjusted death rates than low-fit persons with none of the se characteristics. Conclusions.-Low fitness is an important precursor of mortality. The protective effect of fitness held for smokers and n onsmokers, those with and without elevated cholesterol levels or eleva ted blood pressure, and unhealthy and healthy persons. Moderate fitnes s seems to protect against the influence of these other predictors on mortality. Physicians should encourage sedentary patients to become ph ysically active and thereby reduce the risk of premature mortality.