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.
Washington DC Veterans Affairs Medical Center, Washington, DC, USA; George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
J Am Coll Cardiol. 2022 Aug 9;80(6):598-609. doi: 10.1016/j.jacc.2022.05.031.
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.
The aim of this study was to evaluate the association of CRF and mortality risk across the spectra of age, race, and sex.
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.
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.
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.
心肺适能（CRF）与全因死亡率呈负相关。然而，CRF 与不同种族、女性和老年人的死亡率风险之间的关系尚未得到充分评估。
本研究旨在评估 CRF 与年龄、种族和性别谱中死亡率风险的相关性。
共纳入 750302 名年龄在 30 至 95 岁之间的美国退伍军人（平均年龄 61.3±9.8 岁），包括 70 多岁的老年人（n=110637）、80 多岁的老年人（n=26989）、非裔美国人（n=142798）、西班牙裔（n=35197）、美国原住民（n=16050）和女性（n=45232）。根据标准化跑步机运动试验中达到的峰值代谢当量（METs），确定了年龄和性别特异性 CRF 类别（五分位数和 98 百分位）。使用多变量 Cox 模型估计死亡率在 CRF 类别中的风险比（HRs）和 95%置信区间（CIs）。
在随访期间（中位 10.2 年，7803861 人年观察），174807 名受试者死亡，平均每 1000 人年发生 22.4 例死亡。CRF 与死亡率风险的关联呈负相关，且呈梯度分布，跨越了年龄谱、性别和种族。男性（HR：0.24；95%CI：0.23-0.25）和女性（HR：0.23；95%CI：0.17-0.29）的最低死亡率风险出现在大约 14.0 METs，且没有证据表明极高的 CRF 会增加风险。与体能最佳的个体（第 20 百分位）相比，体能最差的个体（HR：4.09；95%CI：3.90-4.20）的风险增加了 4 倍。
CRF 与死亡率风险之间的关联跨越了年龄谱（包括 70 多岁和 80 多岁的老年人）、男性、女性和所有种族，呈负相关、独立和梯度分布。没有观察到与极端健康相关的风险增加。不健康的身体状况比任何检查的心脏危险因素都更具风险。
