Cardiorespiratory Fitness, Coronary Artery Calcium, and Cardiovascular Disease Events in a Cohort of Generally Healthy Middle-Age Men: Results From the Cooper Center Longitudinal Study.
Level 3 - non-randomized controlled study
Prospective observational cohort study
PubMed 29343464 · doi:10.1161/CIRCULATIONAHA.117.032708
What was done
A prospective cohort study of 8,425 men without clinical cardiovascular disease (CVD) from the Cooper Center Longitudinal Study examined between 1998 and 2007. Baseline evaluations included objective measurement of cardiorespiratory fitness (CRF) and coronary artery calcium (CAC). Over an average follow-up of 8.4 years, 383 CVD events occurred. Parametric proportional hazards regression models using a Gompertz mortality rule evaluated the association of continuous CRF (in METs) and CAC categories (0, 1–99, 100–399, and ≥400) with CVD event risk and total CVD incidence rates at 70 years of age.
What was found
CVD events increased with higher CAC burden and decreased with higher CRF. After adjusting for CAC categories, each additional 1-MET increase in cardiorespiratory fitness was associated with an 11% lower risk of CVD events (hazard ratio, 0.89; 95% confidence interval, 0.84–0.94). The inverse association between continuous CRF and CVD incidence rates persisted across all CAC score groups, including those with CAC scores ≥400.
Why it matters
Cardiorespiratory fitness attenuates cardiovascular event risk across all levels of subclinical coronary calcification. This indicates that higher fitness confers cardiovascular protection even among individuals with significant coronary artery disease burden.
Limits
The study evaluated only men attending a preventive medicine clinic, limiting generalizability to women and other populations. As an observational cohort, residual confounding cannot be ruled out.
Cited by
- supports Nina Radford's Cooper Clinic study demonstrated an interaction between fitness and coronary calcium, such that higher cardiorespiratory fitness reduces the elevated risk associated with high coronary calcium scores.