Combined effects of cardiorespiratory fitness, not smoking, and normal waist girth on morbidity and mortality in men.

BACKGROUND Physical inactivity, cigarette smoking, and abdominal obesity are key modifiable risk factors for coronary heart disease (CHD). We investigated the combined effects of not having these risk factors on CHD events and cardiovascular disease (CVD) and all-cause mortality in men. METHODS We followed up 23 657 men, aged 30 to 79 years, who completed a medical evaluation including a maximal treadmill exercise test and self-reported health habits. A low-risk profile was defined as not smoking, moderate or high fitness, and normal waist girth. There were 482 CHD events (nonfatal myocardial infarction or fatal CHD) and 1034 deaths (306 CVD, 387 cancers, and 341 others) during a mean 14.7 years of follow-up (348 811 man-years). RESULTS After adjustment for age, examination year, and multiple baseline risk factors, there was an inverse association between a greater number of low-risk factors and CHD events, and CVD and all-cause mortality in men (P value for trend, <.001 for all). Men with a normal waist girth and who were physically fit and not smoking had a 59% lower risk of CHD events (95% confidence interval [CI], 39%-72%), a 77% lower risk of CVD mortality (95% CI, 65%-85%), and a 69% lower risk of all-cause mortality (95% CI, 60%-76%) compared with men with none of these low-risk factors. Men with 0 compared with 3 low-risk factors had a shorter life expectancy by 14.2 years (95% CI, 12.2-15.9 years). CONCLUSION Being physically fit, not smoking, and maintaining a normal waist girth is associated with lower risk of CHD events, and CVD and all-cause mortality in men.

[1]  J. Ayres,et al.  A comparative analysis of four protocols for maximal treadmill stress testing. , 1976, American heart journal.

[2]  D P Byar,et al.  Estimating the population attributable risk for multiple risk factors using case-control data. , 1985, American journal of epidemiology.

[3]  J. Neaton,et al.  Is relationship between serum cholesterol and risk of premature death from coronary heart disease continuous and graded? Findings in 356,222 primary screenees of the Multiple Risk Factor Intervention Trial (MRFIT). , 1986, JAMA.

[4]  R S Paffenbarger,et al.  Physical fitness and all-cause mortality. A prospective study of healthy men and women. , 1989, JAMA.

[5]  Changes in Plasma Lipids and Lipoproteins in Overweight Men During Weight Loss Through Dieting As Compared With Exercise , 1989 .

[6]  S. Blair,et al.  Patterns of non-response to a mail survey. , 1990, Journal of clinical epidemiology.

[7]  S. Greenland,et al.  Risk and Rate Advancement Periods as Measures of Exposure Impact on the Occurrence of Chronic Diseases , 1993, Epidemiology.

[8]  R S Paffenbarger,et al.  The association of changes in physical-activity level and other lifestyle characteristics with mortality among men. , 1993, The New England journal of medicine.

[9]  R S Paffenbarger,et al.  Changes in physical fitness and all-cause mortality. A prospective study of healthy and unhealthy men. , 1995, JAMA.

[10]  C. Morrison,et al.  Waist circumference as a measure for indicating need for weight management , 1995, BMJ.

[11]  A. Dyer,et al.  Impact of major cardiovascular disease risk factors, particularly in combination, on 22-year mortality in women and men. , 1998, Archives of internal medicine.

[12]  A. Dyer,et al.  Low risk-factor profile and long-term cardiovascular and noncardiovascular mortality and life expectancy: findings for 5 large cohorts of young adult and middle-aged men and women. , 1999, JAMA.

[13]  K. Flegal,et al.  Prevalence and trends in obesity among US adults, 1999-2000. , 2002, JAMA.

[14]  A. Dyer,et al.  Major Risk Factors as Antecedents of Fatal and Nonfatal Coronary Heart Disease Events , 2003 .

[15]  A. Dyer,et al.  Major risk factors as antecedents of fatal and nonfatal coronary heart disease events. , 2003, JAMA.

[16]  D. Annane,et al.  Corticosteroids for severe sepsis and septic shock: a systematic review and meta-analysis , 2004, BMJ : British Medical Journal.

[17]  Steven Hawken,et al.  Preventive cardiologyAbstractsEffect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): Case-control study , 2004 .

[18]  A. Dyer,et al.  Favorable cardiovascular risk profile in young women and long-term risk of cardiovascular and all-cause mortality. , 2004, JAMA.

[19]  S. Blair,et al.  Coronary artery calcium score and coronary heart disease events in a large cohort of asymptomatic men and women. , 2005, American journal of epidemiology.

[20]  H. Kohl,et al.  Trends in leisure-time physical inactivity by age, sex, and race/ethnicity--United States, 1994-2004. , 2005, MMWR. Morbidity and mortality weekly report.

[21]  Ralph B D'Agostino,et al.  Prediction of Lifetime Risk for Cardiovascular Disease by Risk Factor Burden at 50 Years of Age , 2006, Circulation.

[22]  E. Rimm,et al.  Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men: Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications , 2006, Circulation.

[23]  S. Blair,et al.  Cardiorespiratory fitness as a predictor of nonfatal cardiovascular events in asymptomatic women and men. , 2007, American journal of epidemiology.

[24]  C. Husten,et al.  Cigarette smoking among adults--United States, 2006. , 2007, MMWR. Morbidity and mortality weekly report.

[25]  T. Harris,et al.  The combined relations of adiposity and smoking on mortality. , 2008, The American journal of clinical nutrition.

[26]  Robert Luben,et al.  Combined Impact of Health Behaviours and Mortality in Men and Women: The EPIC-Norfolk Prospective Population Study , 2008, PLoS medicine.

[27]  D.,et al.  Regression Models and Life-Tables , 2022 .