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Prediction of Cardiovascular Mortality by Estimated Cardiorespiratory Fitness Independent of Traditional Risk
Javaid Nauman1, Bjarne M Nes1, Carl J Lavie2
1K.G. Jebsen Center for Exercise in Medicine, Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
Insights
Estimated cardiorespiratory fitness (eCRF) strongly predicts cardiovascular disease (CVD) mortality. Adding traditional risk factors offers minimal improvement, suggesting eCRF is a practical first-line tool for CVD prevention.
Area of Science:
- Cardiology
- Preventive Medicine
- Public Health
Background:
- Cardiovascular disease (CVD) remains a leading cause of mortality worldwide.
- Accurate risk prediction is crucial for effective primary prevention strategies.
- Traditional risk factors (e.g., hypertension, diabetes) are established predictors of CVD events.
Purpose of the Study:
- To evaluate the predictive capability of estimated cardiorespiratory fitness (eCRF) for CVD mortality.
- To determine the incremental value of traditional CVD risk factors when added to eCRF for mortality prediction.
Main Methods:
- A large cohort of healthy adults (n=38,480) aged 30-74 years was studied.
- Cardiorespiratory fitness was estimated using a nonexercise algorithm.
- Cox proportional hazards models and reclassification metrics (C-statistic, NRI) assessed mortality prediction.
Main Results:
- Low eCRF was a significant independent predictor of both CVD and all-cause mortality.
- The predictive accuracy for CVD mortality (C-statistic) was high for eCRF alone.
- Adding traditional clinical variables to eCRF provided only a marginal improvement in risk discrimination.
Conclusions:
- Estimated cardiorespiratory fitness is a powerful, independent predictor of cardiovascular and all-cause mortality.
- Traditional clinical risk factors offer limited additional predictive value beyond eCRF.
- eCRF represents a practical, cost-effective tool for initial risk assessment in primary prevention.
Objective:
To assess the predictive value of estimated cardiorespiratory fitness (eCRF) and evaluate the additional contribution of traditional risk factors in cardiovascular disease (CVD) mortality prediction.
Participants And Methods:
The study included healthy men (n=18,721) and women (n=19,759) aged 30 to 74 years. A nonexercise algorithm estimated cardiorespiratory fitness. Cox proportional hazards models evaluated the primary (CVD mortality) and secondary (all-cause, ischemic heart disease, and stroke mortality) end points. The added predictive value of traditional CVD risk factors was evaluated using the Harrell C statistic and net reclassification improvement.
Results:
After a median follow-up of 16.3 years (range, 0.04-17.4 years), there were 3863 deaths, including 1133 deaths from CVD (734 men and 399 women). Low eCRF was a strong predictor of CVD and all-cause mortality after adjusting for established risk factors. The C statistics for eCRF and CVD mortality were 0.848 (95% CI, 0.836-0.861) and 0.878 (95% CI, 0.862-0.894) for men and women, respectively, increasing to 0.851 (95% CI, 0.839-0.863) and 0.881 (95% CI, 0.865-0.897), respectively, when adding clinical variables. By adding clinical variables to eCRF, the net reclassification improvement of CVD mortality was 0.014 (95% CI, -0.023 to 0.051) and 0.052 (95% CI, -0.023 to 0.127) in men and women, respectively.
Conclusion:
Low eCRF is independently associated with CVD and all-cause mortality. The inclusion of traditional clinical CVD risk factors added little to risk discrimination and did not improve the classification of risk beyond this simple eCRF measurement, which may be proposed as a practical and cost-effective first-line approach in primary prevention settings.
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