Association of Fitness in Young Adulthood With Survival and Cardiovascular Risk: The Coronary Artery Risk Development in Young Adults (CARDIA) Study
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IMPORTANCE: Although cardiorespiratory fitness (CRF) is prognostic in older adults, the effect of CRF during early adulthood on long-term cardiovascular structure, function, and prognosis is less clear. OBJECTIVE: To examine whether CRF in young adults is associated with long-term clinical outcome and subclinical cardiovascular disease (CVD). DESIGN, SETTING, AND PARTICIPANTS: Prospective study of 4872 US adults aged 18 to 30 years who underwent treadmill exercise testing at a baseline study visit from March 25, 1985, to June 7, 1986, and 2472 individuals who underwent a second treadmill test 7 years later. Median follow-up was 26.9 years, with assessment of obesity, left ventricular mass and strain, coronary artery calcification (CAC), and vital status and incident CVD. Follow-up was complete on August 31, 2011, and data were analyzed from recruitment through the end of follow-up. MAIN OUTCOMES AND MEASURES: The presence of CAC was assessed by computed tomography at years 15 (2000-2001), 20 (2005-2006), and 25 (2010-2011), and left ventricular mass was assessed at years 5 (1990-1991) and 25 (with global longitudinal strain). Incident CVD and all-cause mortality were adjudicated. RESULTS: Of the 4872 individuals, 273 (5.6%) died and 193 (4.0%) experienced CVD events during follow-up. After comprehensive adjustment, each additional minute of baseline exercise test duration was associated with a 15% lower hazard of death (hazard ratio [HR], 0.85; 95% CI, 0.80-0.91; P < .001) and a 12% lower hazard of CVD (HR, 0.88; 95% CI, 0.81-0.96; P = .002). Higher levels of baseline CRF were associated with significantly lower left ventricular mass index (β = -0.24; 95% CI, -0.45 to -0.03; P = .02) and significantly better lobal longitudinal strain (β = -0.09; 95% CI, -0.14 to -0.05; P < .001) at year 25. Fitness was not associated with CAC. A 1-minute reduction in fitness by year 7 was associated with 21% and 20% increased hazards of death (HR, 1.21; 95% CI, 1.07-1.37; P = .002) and CVD (HR, 1.20; 95% CI, 1.06-1.37; P = .006), respectively, along with a more impaired strain (β = 0.15; 95% CI, 0.08-0.23; P < .001). No association between change in fitness and CAC was found. CONCLUSIONS AND RELEVANCE: Higher levels of fitness at baseline and improvement in fitness early in adulthood are favorably associated with lower risks for CVD and mortality. Fitness and changes in fitness are associated with myocardial hypertrophy and dysfunction but not CAC. Regular efforts to ascertain and improve CRF in young adulthood may play a critical role in promoting cardiovascular health and interrupting early CVD pathogenesis.
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Other observational studies found either no association or an inverse relationship between physical activity or fitness and CAC.
“other observational studies that found either no association 14-16 or an inverse relationship 17, 18 between physical activity or fitness and CAC”
From Relationship between lifelong exercise volume and coronary atherosclerosis in athletes. (2017) · cites this paper as [14]
Increased cardiorespiratory fitness is associated with numerous cardiovascular and noncardiovascular benefits, including reductions in coronary artery disease, hypertension, diabetes, stroke, and cancer.
“Increased CRF is also associated with numerous cardiovascular and noncardiovascular benefits, including reductions in coronary artery disease (CAD),14 hypertension,15 diabetes,16 stroke,17 and cancer.18”
From Association of Cardiorespiratory Fitness with Long-term Mortality Among Adults Undergoing Exercise Treadmill Testing (2018) · cites this paper as [14]
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Association between Cardiorespiratory Fitness and Lung Health from Young Adulthood to Middle Age
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Lung Function in Young Adults and Risk of Cardiovascular Events Over 29 Years: The CARDIA Study
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Self-citationSudden Cardiac Death in Athletes: Facts and Fallacies
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Comprehensive Metabolic Phenotyping Refines Cardiovascular Risk in Young Adults
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Fatores associados à prática de Atividade Física na população brasileira - Vigitel 2013
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Cardiovascular Risk Assessment in the Older Athlete
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Impact of educational programme on patient's health outcomes following open heart surgeries
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Tackling non-communicable disease risk in young adults across the Caribbean: a call to action
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- Authors
- Shah, R. V., Murthy, V. L., Colangelo, L. A., Reis, J., Venkatesh, B. A., Sharma, R., Abbasi, S. A., Goff, D. C., Carr, J. J., Rana, J. S., Terry, J. G., Bouchard, C., Sarzynski, M. A., Eisman, A., Neilan, T., Das, S., Jerosch-Herold, M., Lewis, C. E., Carnethon, M., Lewis, G. D., & Lima, J. A. C.
- Affiliations
- Beth Israel Deaconess Medical Center (US)
- University of Michigan (US)
- Northwestern University (US)
- National Heart, Lung, and Blood Institute (US)
- Department of Medicine and Cardiology, Heart and Vascular Institute, Johns Hopkins Medical Institutions, The Johns Hopkins University, Baltimore, Maryland
- Johns Hopkins University (US)
- Brown University (US)
- Colorado School of Public Health (US)
- Vanderbilt University (US)
- Kaiser Permanente (US)
- Pennington Biomedical Research Center (US)
- Massachusetts General Hospital (US)
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts15Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts
- University of Alabama at Birmingham (US)
- ORCID
- Venue
- JAMA Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2016-01-01
- Volume
- 176
- Issue
- 1
- Pages
- 87
- ISSN
- 2168-6106 (ISSN-L)
- PMC
- PMC5292201
- OpenAlex
- W2189298137
- Cited by
- 158
- References
- 52
- Citations by year
- 2026: 13 · 2025: 6 · 2024: 20 · 2023: 10 · 2022: 16 · 2021: 15 · 2020: 11 · 2019: 15 · 2018: 17 · 2017: 22 · 2016: 13
- FWCI
- 34.04
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- American Heart Association
- National Institutes of Health (n01hc95164-17-0-1, n01hc95165-34-0-1, n01hc95161-24-0-1, n01hc095169-003, n01hc95166-21-0-1, n01hc95162-31-0-1, n01hc95168-27-0-1, n01hc95160-18-0-1, n01hc95163-22-0-1, n01hc95159-40-0-1, UL1TR000040)
- National Institute on Aging (AG 0005)
- National Heart, Lung, and Blood Institute (HHSN268201300028C, N01 HC-95159, N01-HC-95160, N01-HC095169, N01 HC-95168, N01-HC-095165, HHS-N2-68201300029C, HHSN268201300027C, (N01-HC-95163, N01 HC095163, N01 HC-95161, N01 HC95165, N01HC95164, HHSN268200900041C, N01-HC-095159, N01 HC095168, HHSN268201300026C, N01-HC-095162, HHS-N2-68201300025C, N01-HC-095161, N01-HC-095160, N01 HC095166, N01 HC095164, N01‐HC‐95166, HL098445-05, N01 HC-95162, R01HL098445, N01 HC95169)
- National Institute of General Medical Sciences (P20GM103652, 8P20 GM-1033528)
- National Center for Research Resources (UL1RR025005)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Effects of Exercise
- Keywords
- cardiorespiratory fitness, early adulthood, all-cause mortality, cardiovascular disease incidence, coronary artery calcification, left ventricular mass, global longitudinal strain, subclinical cardiovascular disease, exercise capacity, cardiovascular risk, obesity, treadmill exercise testing, long-term prognosis, racial and ethnic disparities, sex differences, socioeconomic status
- MeSH terms
- Adolescent, Adult, Cardiovascular Diseases, Coronary Artery Disease, Exercise Test, Female, Heart Ventricles, Humans, Longitudinal Studies, Male, Middle Aged, Mortality, Obesity, Physical Fitness, Prospective Studies, Tomography, X-Ray Computed, Ultrasonography, United States, Proportional Hazards Models, Hypertrophy, Left Ventricular, Young Adult, Asymptomatic Diseases, Vascular Calcification
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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