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Cardiorespiratory fitness as a predictor of short‐term and lifetime estimated cardiovascular disease risk

Development of cardiovascular disease (CVD) remains a public health concern for young to middle‐aged adults, now exacerbated by the increasing prevalence of obesity and sedentary lifestyles. Cardiorespiratory fitness (CRF) improves the reclassification of short‐term (10‐year) CVD risk, but has not been uniformly defined across studies. This study evaluated cross‐sectional differences in short‐term and lifetime CVD risk scores, across both absolute metabolic equivalent (MET) and sex‐ and age‐standardized CRF categories in 805 apparently healthy young to middle‐aged adults (68% male; 47.4 ± 7.2 years). CVD risk factors were evaluated, and estimated cardiorespiratory fitness (CRF) measurements (METS and peak VO2) were derived from a submaximal Bruce treadmill test. CRF measures also included post‐exercise heart rate recovery (HRR) data. Consistent trends showing more favorable risk factor profiles and lower short‐term CVD (QRISK2), and CVD mortality (SCORE) scores, associated with higher levels of CRF were evident in both sexes. Lifetime CVD risk (Q‐Lifetime) was highest in the lowest CRF categories. Peak VO2 and HRR following submaximal exercise testing contributed to the variability in short‐term and lifetime CVD risk. Global CVD risk predictions were examined across different contemporary CRF classifications with inconsistent findings. Recommended absolute MET and sex‐ and age‐standardized CRF categories were significantly associated with both short‐term and lifetime risk of CVD outcomes. However, compared to internationally derived normative CRF standards, cohort‐specific CRF categories resulted in markedly different proportion of individuals classified in the “poor” CRF category at higher CVD risk.