LAUSR

Abstract Purpose: We aimed to assess the associations of oxygen uptake at aerobic threshold (VO2 at AT) with cardiovascular and all-cause mortality. Design: VO2 at AT was assessed in 1663 middle-aged men in a cohort study. Hazard ratios (HRs) were calculated for sudden cardiac death (SCD), fatal coronary heart disease (CHD) and cardiovascular disease (CVD) and all-cause mortality. Results: During a median follow-up of 25.6 years, 138 SCDs, 209 fatal CHDs, 333 fatal CVDs and 719 all-cause mortality events occurred. On adjustment for established risk factors, the HRs (95% CIs) for SCD, fatal CHD, fatal CVD and all-cause mortality were 0.48 (0.28–0.82), 0.48 (0.31–0.74), 0.57 (0.41–0.79) and 0.66 (0.53–0.82), respectively comparing extreme quartiles of VO2 at AT. On further adjustment for peak VO2, the HRs were 0.87 (0.48–1.56), 0.83 (0.52–1.34), 0.91 (0.63–1.30) and 0.88 (0.69–1.12), respectively. Addition of VO2 at AT to a standard CVD mortality risk prediction model was associated with a C-index change of 0.0085 (95% CI: −0.0002–0.0172; p = .05) at 25 years. Conclusions: VO2 at AT is inversely associated with cardiovascular and all-cause mortality events, but the associations are partly dependent on peak VO2. VO2 at AT may improve the prediction of the long-term risk for CVD mortality. KEY MESSAGES Oxygen uptake at aerobic threshold (VO2 at AT), a cardiopulmonary exercise testing parameter, may be a useful prognostic tool for adverse clinical outcomes in the general population. In a population-based prospective cohort study of men, VO2 at AT was inversely associated with cardiovascular and all-cause mortality events and improved the prediction of cardiovascular mortality. In populations who cannot achieve maximal VO2, VO2 at AT may serve as a useful prognostic tool; however, further studies are warranted.