Oxygen uptake at aerobic threshold is inversely associated with fatal cardiovascular and all-cause mortality events

Ann Med. 2017 Dec;49(8):698-709. doi: 10.1080/07853890.2017.1367958. Epub 2017 Aug 22.


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.

Keywords: Oxygen uptake at aerobic threshold; cardiopulmonary exercise testing; cardiovascular disease; mortality; risk prediction.

MeSH terms

  • Anaerobic Threshold / physiology*
  • Cardiovascular Diseases / mortality*
  • Cause of Death
  • Coronary Disease / mortality
  • Death, Sudden, Cardiac / epidemiology*
  • Humans
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Oxygen / metabolism*
  • Oxygen Consumption / physiology*
  • Proportional Hazards Models
  • Prospective Studies
  • Risk Factors


  • Oxygen