Midlife Cardiorespiratory Fitness and the Long-Term Risk of Mortality: 46 Years of Follow-Up

Johan S.R. Clausen, Jacob L. Marott, Andreas Holtermann, Finn Gyntelberg, Magnus T. Jensen*

*Kontaktforfatter for dette arbejde

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

Background: A high cardiorespiratory fitness (CRF) level is recommended to promote healthy aging. However, the association between CRF and very-long-term prognosis is unclear, and reverse causation may bias results in studies with shorter follow-up. Objectives: This study investigated the association between CRF and mortality in middle-aged, employed men free of cardiovascular disease (CVD). Methods: Participants from the Copenhagen Male Study, established in 1970 to 1971, were included and stratified into 4 age-adjusted maximal oxygen consumption (VO2max) categories: below the lower limit of normal (lowest 5%); low normal (45%); high normal (45%); and above the upper limit of normal (top 5%). VO2max was estimated by using a bicycle ergometer. Multivariable restricted mean survival time models were performed for all-cause and cardiovascular mortality using Danish national registers. Results: A total of 5,107 men with a mean age of 48.8 ± 5.4 years were included in the study. During the 46 years of follow-up, 4,700 (92%) men died; 2,149 (42.1%) of the men died of CVD. Compared with below the lower limit of normal CRF, low normal CRF was associated with 2.1 years (95% confidence interval [CI]: 0.7 to 3.4; p = 0.002), high normal with 2.9 years (95% CI: 1.5 to 4.2; p < 0.001), and above upper limit of normal with 4.9 years (95% CI: 3.1 to 6.7; p < 0.001) longer mean life expectancy. Each unit increase in VO2max was associated with a 45-day (95% CI: 30 to 61; p < 0.001) increase in longevity. Estimates for cardiovascular mortality were similar to all-cause mortality. Results were essentially unchanged when excluding individuals who died within the first 10 years of follow-up, suggesting a minimal role of reverse causation. Conclusions: CRF was significantly related to longevity over the course of 4 decades in middle-aged, employed men free of CVD. The benefits of higher midlife CRF extend well into the later part of life.

OriginalsprogEngelsk
TidsskriftJournal of the American College of Cardiology
Vol/bind72
Udgave nummer9
Sider (fra-til)987-995
ISSN0735-1097
DOI
StatusUdgivet - 28. aug. 2018

Fingeraftryk

Confidence Intervals
Causality
Life Expectancy
Cardiorespiratory Fitness
Oxygen Consumption
Survival Rate

Citer dette

Clausen, Johan S.R. ; Marott, Jacob L. ; Holtermann, Andreas ; Gyntelberg, Finn ; Jensen, Magnus T. / Midlife Cardiorespiratory Fitness and the Long-Term Risk of Mortality : 46 Years of Follow-Up. I: Journal of the American College of Cardiology. 2018 ; Bind 72, Nr. 9. s. 987-995.
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title = "Midlife Cardiorespiratory Fitness and the Long-Term Risk of Mortality: 46 Years of Follow-Up",
abstract = "Background: A high cardiorespiratory fitness (CRF) level is recommended to promote healthy aging. However, the association between CRF and very-long-term prognosis is unclear, and reverse causation may bias results in studies with shorter follow-up. Objectives: This study investigated the association between CRF and mortality in middle-aged, employed men free of cardiovascular disease (CVD). Methods: Participants from the Copenhagen Male Study, established in 1970 to 1971, were included and stratified into 4 age-adjusted maximal oxygen consumption (VO2max) categories: below the lower limit of normal (lowest 5{\%}); low normal (45{\%}); high normal (45{\%}); and above the upper limit of normal (top 5{\%}). VO2max was estimated by using a bicycle ergometer. Multivariable restricted mean survival time models were performed for all-cause and cardiovascular mortality using Danish national registers. Results: A total of 5,107 men with a mean age of 48.8 ± 5.4 years were included in the study. During the 46 years of follow-up, 4,700 (92{\%}) men died; 2,149 (42.1{\%}) of the men died of CVD. Compared with below the lower limit of normal CRF, low normal CRF was associated with 2.1 years (95{\%} confidence interval [CI]: 0.7 to 3.4; p = 0.002), high normal with 2.9 years (95{\%} CI: 1.5 to 4.2; p < 0.001), and above upper limit of normal with 4.9 years (95{\%} CI: 3.1 to 6.7; p < 0.001) longer mean life expectancy. Each unit increase in VO2max was associated with a 45-day (95{\%} CI: 30 to 61; p < 0.001) increase in longevity. Estimates for cardiovascular mortality were similar to all-cause mortality. Results were essentially unchanged when excluding individuals who died within the first 10 years of follow-up, suggesting a minimal role of reverse causation. Conclusions: CRF was significantly related to longevity over the course of 4 decades in middle-aged, employed men free of CVD. The benefits of higher midlife CRF extend well into the later part of life.",
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author = "Clausen, {Johan S.R.} and Marott, {Jacob L.} and Andreas Holtermann and Finn Gyntelberg and Jensen, {Magnus T.}",
year = "2018",
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Midlife Cardiorespiratory Fitness and the Long-Term Risk of Mortality : 46 Years of Follow-Up. / Clausen, Johan S.R.; Marott, Jacob L.; Holtermann, Andreas; Gyntelberg, Finn; Jensen, Magnus T.

I: Journal of the American College of Cardiology, Bind 72, Nr. 9, 28.08.2018, s. 987-995.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Midlife Cardiorespiratory Fitness and the Long-Term Risk of Mortality

T2 - 46 Years of Follow-Up

AU - Clausen, Johan S.R.

AU - Marott, Jacob L.

AU - Holtermann, Andreas

AU - Gyntelberg, Finn

AU - Jensen, Magnus T.

PY - 2018/8/28

Y1 - 2018/8/28

N2 - Background: A high cardiorespiratory fitness (CRF) level is recommended to promote healthy aging. However, the association between CRF and very-long-term prognosis is unclear, and reverse causation may bias results in studies with shorter follow-up. Objectives: This study investigated the association between CRF and mortality in middle-aged, employed men free of cardiovascular disease (CVD). Methods: Participants from the Copenhagen Male Study, established in 1970 to 1971, were included and stratified into 4 age-adjusted maximal oxygen consumption (VO2max) categories: below the lower limit of normal (lowest 5%); low normal (45%); high normal (45%); and above the upper limit of normal (top 5%). VO2max was estimated by using a bicycle ergometer. Multivariable restricted mean survival time models were performed for all-cause and cardiovascular mortality using Danish national registers. Results: A total of 5,107 men with a mean age of 48.8 ± 5.4 years were included in the study. During the 46 years of follow-up, 4,700 (92%) men died; 2,149 (42.1%) of the men died of CVD. Compared with below the lower limit of normal CRF, low normal CRF was associated with 2.1 years (95% confidence interval [CI]: 0.7 to 3.4; p = 0.002), high normal with 2.9 years (95% CI: 1.5 to 4.2; p < 0.001), and above upper limit of normal with 4.9 years (95% CI: 3.1 to 6.7; p < 0.001) longer mean life expectancy. Each unit increase in VO2max was associated with a 45-day (95% CI: 30 to 61; p < 0.001) increase in longevity. Estimates for cardiovascular mortality were similar to all-cause mortality. Results were essentially unchanged when excluding individuals who died within the first 10 years of follow-up, suggesting a minimal role of reverse causation. Conclusions: CRF was significantly related to longevity over the course of 4 decades in middle-aged, employed men free of CVD. The benefits of higher midlife CRF extend well into the later part of life.

AB - Background: A high cardiorespiratory fitness (CRF) level is recommended to promote healthy aging. However, the association between CRF and very-long-term prognosis is unclear, and reverse causation may bias results in studies with shorter follow-up. Objectives: This study investigated the association between CRF and mortality in middle-aged, employed men free of cardiovascular disease (CVD). Methods: Participants from the Copenhagen Male Study, established in 1970 to 1971, were included and stratified into 4 age-adjusted maximal oxygen consumption (VO2max) categories: below the lower limit of normal (lowest 5%); low normal (45%); high normal (45%); and above the upper limit of normal (top 5%). VO2max was estimated by using a bicycle ergometer. Multivariable restricted mean survival time models were performed for all-cause and cardiovascular mortality using Danish national registers. Results: A total of 5,107 men with a mean age of 48.8 ± 5.4 years were included in the study. During the 46 years of follow-up, 4,700 (92%) men died; 2,149 (42.1%) of the men died of CVD. Compared with below the lower limit of normal CRF, low normal CRF was associated with 2.1 years (95% confidence interval [CI]: 0.7 to 3.4; p = 0.002), high normal with 2.9 years (95% CI: 1.5 to 4.2; p < 0.001), and above upper limit of normal with 4.9 years (95% CI: 3.1 to 6.7; p < 0.001) longer mean life expectancy. Each unit increase in VO2max was associated with a 45-day (95% CI: 30 to 61; p < 0.001) increase in longevity. Estimates for cardiovascular mortality were similar to all-cause mortality. Results were essentially unchanged when excluding individuals who died within the first 10 years of follow-up, suggesting a minimal role of reverse causation. Conclusions: CRF was significantly related to longevity over the course of 4 decades in middle-aged, employed men free of CVD. The benefits of higher midlife CRF extend well into the later part of life.

KW - cardiovascular mortality

KW - cohort study

KW - exercise test

KW - longevity

KW - middle-aged

KW - physical fitness

UR - http://www.scopus.com/inward/record.url?scp=85051141802&partnerID=8YFLogxK

U2 - 10.1016/j.jacc.2018.06.045

DO - 10.1016/j.jacc.2018.06.045

M3 - Journal article

C2 - 30139444

AN - SCOPUS:85051141802

VL - 72

SP - 987

EP - 995

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

IS - 9

ER -