{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T05:35:58Z","timestamp":1793424958238,"version":"4.5.0"},"reference-count":36,"publisher":"Oxford University Press (OUP)","funder":[{"DOI":"10.13039\/100000738","name":"U.S. Department of Veterans Affairs","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Veterans Health Administration, Office of Research and Development","id":[{"id":"https:\/\/ror.org\/011qyt180","id-type":"ROR","asserted-by":"crossref"}]},{"DOI":"10.13039\/100006380","name":"Rehabilitation Research and Development Service","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006380","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Low cardiorespiratory fitness (CRF) and traditional cardiovascular risk factors are associated with mortality, but their relative contributions to mortality and the independent association of CRF remain incompletely understood.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>We analysed a large Veterans Administration cohort undergoing maximal exercise testing (n = 580 290; mean age 65.1 \u00b1 9.7 years) and followed them for 10.2 \u00b1 5.1 years. Relative risks (RRs) for mortality were estimated using Poisson regression with robust (HC3) standard errors across nested models adjusting sequentially for age, sex, body mass index, diabetes, smoking, and statin therapy. Population attributable risks (PARs) and exposure impact numbers (EINs) were calculated for low CRF and other major risk factors. Individuals in the highest CRF quintile had approximately 74% lower mortality vs. those in the lowest quintile (&amp;lt;5 metabolic equivalents of task). Hypertension had the greatest population-level impact [PAR 21.8%; 95% confidence interval (CI) 15.2\u201328.0], followed by low CRF (PAR 14.7%; 95% CI 8.1\u201321.1). In a fully adjusted sensitivity analysis, low CRF demonstrated the strongest independent association with mortality (RR 1.77; 95% CI 1.75\u20131.79) compared with hypertension (RR 1.33; 95% CI 1.32\u20131.35). Absolute EIN was lowest for low CRF (2.36), suggesting that for every 100 individuals whose fitness improved over the observed follow-up period, approximately 24 fewer deaths would be expected.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Low CRF and hypertension were the strongest predictors of mortality and accounted for the greatest proportion of population-level risk. These findings support CRF as a modifiable clinical vital sign and highlight the complementary importance of fitness promotion and blood pressure control for reducing mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Lay summary<\/jats:title>\n                    <jats:p>Low cardiorespiratory fitness (CRF) is a strong predictor of mortality and is increasingly recognized as a clinical vital sign. However, the relative impact of low CRF on survival compared with traditional risk factors such as smoking, hyperlipidaemia, high blood pressure, and diabetes remain unclear. In this large cohort of more than 580 000 individuals, CRF was measured using a maximal exercise test, traditional risk factors were assessed, and participants were followed for approximately 10 years. Population attributable risk estimates the proportion of deaths that may be associated with a particular risk factor at the population level.Compared with other traditional risk factors, low CRF demonstrated one of the strongest independent associations with mortality.High blood pressure and low CRF accounted for the greatest proportion of deaths over the follow-up period (21.8% and 14.7%, respectively).The results suggest that among every 100 individuals whose fitness improved over the observed follow-up period, approximately 24 fewer deaths would be expected, an effect magnitude greater than other traditional risk factors.<\/jats:p>\n                    <jats:p>These findings support routine assessment of CRF in clinical practice and reinforce physical activity and fitness promotion as central strategies for reducing population-level mortality alongside traditional risk-factor management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/eurjpc\/zwag471","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T11:15:29Z","timestamp":1788520529000},"source":"Crossref","is-referenced-by-count":1,"title":["Cardiorespiratory fitness and population attributable risk: the ETHOS study"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2592-136X","authenticated-orcid":false,"given":"Jonathan","family":"Myers","sequence":"first","affiliation":[{"name":"Cardiology Division, Veterans Affairs Palo Alto Health Care System , Cardiology 111C, 3801 Miranda Avenue, Palo Alto, CA 94304 ,","place":["USA"]},{"name":"Cardiovascular Institute, Stanford University , 265 Campus Drive, G1120, Stanford, CA 94305 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Kokkinos","sequence":"additional","affiliation":[{"name":"Department of Kinesiology and Health, Rutgers University , New Brunswick, NJ ,","place":["USA"]},{"name":"Department of Cardiology, Washington DC VA Medical Center , Washington, DC ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khin","family":"Chan","sequence":"additional","affiliation":[{"name":"Cardiology Division, Veterans Affairs Palo Alto Health Care System , Cardiology 111C, 3801 Miranda Avenue, Palo Alto, CA 94304 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Cadenas-Sanchez","sequence":"additional","affiliation":[{"name":"Department of Physical Education and Sports Sciences, University of Granada , Granada ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Immanuel Babu Henry","family":"Samuel","sequence":"additional","affiliation":[{"name":"Veterans Affairs Medical Center, War Related Illness Study Center , Washington, DC ,","place":["USA"]},{"name":"Henry M. Jackson Foundation for the Advancement of Military Medicine , Bethesda, MD ,","place":["USA"]},{"name":"Biomedical Research Artificial Intelligence and Neuroimaging Lab, Veterans Affairs Medical Center , 50 Irving St NW, Washington, DC 20422 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Pittaras","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Washington DC VA Medical Center , Washington, DC ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Faselis","sequence":"additional","affiliation":[{"name":"Department of Medicine, Veterans Affairs Palo Alto Health Care System , Palo Alto, CA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,9,4]]},"reference":[{"key":"2026091722311961600_zwag471-B1","first-page":"e41","article-title":"2025 Heart Disease and Stroke Statistics: a report of 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