Cardiorespiratory Fitness and Mortality Risk Across the Spectra of Age, Race, and Sex

Peter Kokkinos, Washington DC Veterans Affairs Medical Center, Washington, DC, USA; Department of Kinesiology and Health, School of Arts and Sciences, Rutgers University, New Brunswick, New Jersey, USA; George Washington University School of Medicine and Health Sciences, Washington, DC, USA. Electronic address: peter.kokkinos@va.gov.
Charles Faselis, Washington DC Veterans Affairs Medical Center, Washington, DC, USA; George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Immanuel Babu Samuel, War Related Illness and Injury Study Center, Washington DC Veterans Affairs Medical Center, Washington, DC, USA; The Henry Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA.
Andreas Pittaras, Washington DC Veterans Affairs Medical Center, Washington, DC, USA; George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Michael Doumas, Washington DC Veterans Affairs Medical Center, Washington, DC, USA; Aristotle University of Thessaloniki, Thessaloniki, Greece.
Rayelynn Murphy, Washington DC Veterans Affairs Medical Center, Washington, DC, USA.
Michael S. Heimall, Washington DC Veterans Affairs Medical Center, Washington, DC, USA.
Xuemei Sui, Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA.
Jiajia Zhang, Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, South Carolina, USA.
Jonathan Myers, Palo Alto Health Care System, Veterans Affairs Medical Center, Palo Alto, California, USA; Department of Cardiology, Stanford University, Stanford, California, USA.

Document Type

Journal Article

Publication Date

8-9-2022

Journal

Journal of the American College of Cardiology

Volume

80

Issue

6

DOI

10.1016/j.jacc.2022.05.031

Keywords

aging; fitness; mortality; race

Abstract

BACKGROUND: Cardiorespiratory fitness (CRF) is inversely associated with all-cause mortality. However, the association of CRF and mortality risk for different races, women, and elderly individuals has not been fully assessed. OBJECTIVES: The aim of this study was to evaluate the association of CRF and mortality risk across the spectra of age, race, and sex. METHODS: A total of 750,302 U.S. veterans aged 30 to 95 years (mean age 61.3 ± 9.8 years) were studied, including septuagenarians (n = 110,637), octogenarians (n = 26,989), African Americans (n = 142,798), Hispanics (n = 35,197), Native Americans (n = 16,050), and women (n = 45,232). Age- and sex-specific CRF categories (quintiles and 98th percentile) were established objectively on the basis of peak METs achieved during a standardized exercise treadmill test. Multivariable Cox models were used to estimate HRs and 95% CIs for mortality across the CRF categories. RESULTS: During follow-up (median 10.2 years, 7,803,861 person-years of observation), 174,807 subjects died, averaging 22.4 events per 1,000 person-years. The adjusted association of CRF and mortality risk was inverse and graded across the age spectrum, sex, and race. The lowest mortality risk was observed at approximately 14.0 METs for men (HR: 0.24; 95% CI: 0.23-0.25) and women (HR: 0.23; 95% CI: 0.17-0.29), with no evidence of an increase in risk with extremely high CRF. The risk for least fit individuals (20th percentile) was 4-fold higher (HR: 4.09; 95% CI: 3.90-4.20) compared with extremely fit individuals. CONCLUSIONS: The association of CRF and mortality risk across the age spectrum (including septuagenarians and octogenarians), men, women, and all races was inverse, independent, and graded. No increased risk was observed with extreme fitness. Being unfit carried a greater risk than any of the cardiac risk factors examined.

Department

Medicine

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