Influences of cardiorespiratory fitness and other precursors on cardiovascular disease and all-cause mortality in men and women
Influences of cardiorespiratory fitness and other precursors on cardiovascular disease and all-cause mortality in men and women
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DOI：
10.1001/jama.276.3.205
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发表时间：
1996-07-17
影响因子：
120.7
通讯作者：
Gibbons, LW
中科院分区：
文献类型：
--
作者：
Blair, SN;Kampert, JB;Gibbons, LW
目标。-量化心肺健康与心血管疾病（CVD）死亡率和其他易导致早期死亡的个人特征层内全因死亡率的关系。-观察性队列研究。我们根据吸烟习惯、胆固醇水平、血压和健康状况计算了低（最不适合20%）、中等（最适合40%）和高（最适合40%）健康类别的心血管疾病和全因死亡率。-预防医学门诊。研究参与者。参与者是25 341名男性和7080名女性，他们完成了预防性医学检查，包括最大运动测试。主要结果测量。-心血管疾病和全因死亡率。在211 996个男性年的随访中有601例死亡，在52 982个女性年的随访中有89例死亡。校正相对危险度（RRs）和95%可信区间（Cls）的男性死亡率独立预测因子为：健康状况不佳（RR, 1.52; 95% CI, 1.28-1.82）、吸烟（RR, 1.65; 95% CI, 1.39-1.97）、心电图异常（RR, 1.64; 95% CI, 1.34-2.01）、慢性疾病（RR, 1.63; 95% CI, 1.37-1.95）、胆固醇水平升高（RR, 1.34; 95% CI, 1.13-1.59）、收缩压升高(RR, 1.34；女性死亡率的唯一具有统计学意义的独立预测因子是低健康（RR, 2.10; 95% CI, 1.36-3.21）和吸烟（RR, 1.99; 95% CI, 1.25-3.17）。在其他死亡率预测因子的分层中，两性的健康类别死亡率呈反梯度。吸烟、血压升高或胆固醇水平升高的健康人的调整死亡率低于没有这些特征的健康人。低适应性是死亡的重要前兆。健康的保护作用适用于吸烟者和不吸烟者、胆固醇水平升高和血压不升高的人、不健康的人和健康的人。适度的健康似乎可以防止这些其他预测因素对死亡率的影响。医生应该鼓励久坐不动的病人多运动，从而降低过早死亡的风险。
Objective.-To quantify the relation of cardiorespiratory fitness to cardiovascular disease (CVD) mortality and to all-cause mortality within strata of other personal characteristics that predispose to early mortality.Design.-Observational cohort study. We calculated CVD and all-cause death rates for low (least fit 20%), moderate (next 40%), and high (most fit 40%) fitness categories by strata of smoking habit, cholesterol level, blood pressure, and health status.Setting.-Preventive medicine clinic.Study Participants.-Participants were 25 341 men and 7080 women who completed preventive medical examinations, including a maximal exercise test.Main Outcome Measures.-Cardiovascular disease and all-cause mortality.Results.-There were 601 deaths during 211 996 man-years of follow-up, and 89 deaths during 52 982 woman-years of follow-up. Independent predictors of mortality among men, with adjusted relative risks (RRs) and 95% confidence intervals (Cls), were low fitness (RR, 1.52; 95% CI, 1.28-1.82), smoking (RR, 1.65; 95% CI, 1.39-1.97), abnormal electrocardiogram (RR, 1.64; 95% CI, 1.34-2.01), chronic illness (RR, 1.63; 95% CI, 1.37-1.95), increased cholesterol level (RR, 1.34; 95% CI, 1.13-1.59), and elevated systolic blood pressure (RR, 1.34; 95% CI, 1.13-1.59), The only statistically significant independent predictors of mortality in women were low fitness (RR, 2.10; 95% CI, 1.36-3.21) and smoking (RR, 1.99; 95% CI, 1.25-3.17). Inverse gradients were seen for mortality across fitness categories within strata of other mortality predictors for both sexes. Fit persons with any combination of smoking, elevated blood pressure, or elevated cholesterol level had lower adjusted death rates than low-fit persons with none of these characteristics.Conclusions.-Low fitness is an important precursor of mortality. The protective effect of fitness held for smokers and nonsmokers, those with and without elevated cholesterol levels or elevated blood pressure, and unhealthy and healthy persons. Moderate fitness seems to protect against the influence of these other predictors on mortality. Physicians should encourage sedentary patients to become physically active and thereby reduce the risk of premature mortality.