TY - JOUR
T1 - Prediction of 30-year risk for cardiovascular mortality by fitness and risk factor levels
T2 - The cooper center longitudinal study
AU - Wickramasinghe, Chanaka D.
AU - Ayers, Colby R.
AU - Das, Sandeep
AU - De Lemos, James A.
AU - Willis, Benjamin L.
AU - Berry, Jarett D.
N1 - Publisher Copyright:
© 2014 American Heart Association, Inc.
PY - 2014/7/1
Y1 - 2014/7/1
N2 - 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 causespecific 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 (Nam- D'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.
AB - 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 causespecific 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 (Nam- D'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.
KW - Cardiovascular diseases
KW - Mortality
KW - Risk factors
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U2 - 10.1161/CIRCOUTCOMES.113.000531
DO - 10.1161/CIRCOUTCOMES.113.000531
M3 - Article
C2 - 24987054
AN - SCOPUS:84925845268
SN - 1941-7713
VL - 7
SP - 597
EP - 602
JO - Circulation: Cardiovascular Quality and Outcomes
JF - Circulation: Cardiovascular Quality and Outcomes
IS - 4
ER -