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Cardiovascular Fitness as a Predictor of Mortality in Men
Jari A. Laukkanen, MD;
Timo A. Lakka, MD, PhD;
Rainer Rauramaa, MD, PhD, MSc;
Raimo Kuhanen, MSc;
Juha M. Venäläinen, MD;
Riitta Salonen, MD, PhD;
Jukka T. Salonen, MD, PhD, MScPH
Arch Intern Med. 2001;161:825-831.
Objective To examine the relations of cardiorespiratory fitness, as measured by
maximal oxygen uptake and exercise test duration at the initiation of the
study, with overall, cardiovascular disease (CVD)–related, and non–CVD-related
mortality.
Methods A population-based cohort study of 1294 men with no CVD, pulmonary disease,
or cancer at baseline in Kuopio and surrounding communities in eastern Finland.
During an average follow-up of 10.7 years, there were 124 overall, 42 CVD-related,
and 82 non–CVD-related deaths.
Results The relative risk of overall death in unfit men (maximal oxygen uptake
<27.6 mL/kg per minute) was 2.76 (95% confidence interval, 1.43-5.33) (P = .002), and the relative risk of CVD-related death was
3.09 (95% confidence interval, 1.10-9.56) (P = .05),
compared with fit men (maximal oxygen uptake >37.1 mL/kg per minute) after
adjusting for age, examination years, smoking, and alcohol consumption. The
relative risk of non–CVD-related death in unfit men was almost the same
magnitude as for overall death. Furthermore, adjustment for serum lipid levels,
blood pressure, plasma fibrinogen level, diabetes, and fasting serum insulin
level did not weaken these associations significantly. Exercise test duration
also had a strong inverse relation to overall, CVD-related, and non–CVD-related
mortality. Poor cardiorespiratory fitness was comparable with elevated systolic
blood pressure, smoking, obesity, and diabetes in importance as a risk factor
for mortality.
Conclusions Cardiorespiratory fitness had a strong, graded, inverse association
with overall, CVD-related, and non–CVD-related mortality. Maximal oxygen
uptake and exercise test duration represent the strongest predictors of mortality.
From the Research Institute of Public Health (Drs Laukkanen, Lakka,
R. Salonen, and J. T. Salonen) and the Department of Community Health and
General Practice, University of Kuopio (Drs R. Salonen and J. T. Salonen);
Inner Savo Health Center (J. T. Salonen); and the Kuopio Research Institute
of Exercise Medicine (Drs Rauramaa and Venäläinen and Mr Kuhanen),
Kuopio, Finland.
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