Journal
CIRCULATION-CARDIOVASCULAR QUALITY AND OUTCOMES
Volume 7, Issue 4, Pages 597-602Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1161/CIRCOUTCOMES.113.000531
Keywords
cardiovascular diseases; mortality; risk factors
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Funding
- Dedman Family Scholar in Clinical Care endowment at University of Texas Southwestern Medical Center
- National Heart, Lung and Blood Institute [K23 HL092229]
- American Heart Association [13GRNT14560079]
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Background-Fitness and traditional risk factors have well-known associations with cardiovascular disease (CVD) death in both short-term (10 years) and across the remaining lifespan. However, currently available short-term and long-term risk prediction tools do not incorporate measured fitness. Methods and Results-We included 16 533 participants from the Cooper Center Longitudinal Study (CCLS) without prior CVD. Fitness was measured using the Balke protocol. Sex-specific fitness levels were derived from the Balke treadmill times and categorized into low, intermediate, and high fit according to age-and sex-specific treadmill times. Sex-specific 30-year risk estimates for CVD death adjusted for competing risk of non-CVD death were estimated using the cause-specific hazards model and included age, body mass index, systolic blood pressure, fitness, diabetes mellitus, total cholesterol, and smoking. During a median follow-up period of 28 years, there were 1123 CVD deaths. The 30-year risk estimates for CVD mortality derived from the cause-specific hazards model demonstrated overall good calibration (NamD'Agostino.2 [men, P=0.286; women, P=0.664] and discrimination (c statistic; men, 0.81 [0.80-0.82] and women, 0.86 [0.82-0.91]). Across all risk factor strata, the presence of low fitness was associated with a greater 30-year risk for CVD death. Conclusions-Fitness represents an important additional covariate in 30-year risk prediction functions that may serve as a useful tool in clinical practice.
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