Studies have found that higher levels of cardiorespiratory fitness and light to moderate
alcohol intake reduce the risk for premature death. Scant evidence, however, exists
assessing the joint effects of both measures on all-cause and cardiovascular disease
This study aims to examine the independent and joint effects of alcohol consumption
and cardiorespiratory fitness on all-cause and cardiovascular-related mortality in
a large cohort of men.
This prospective study included 29,402 men who came to the Cooper Clinic (Dallas,
TX) for a preventive medicine visit from 1973 to 2006. Data were analyzed in 2011.
The primary exposure variables were tertiles of cardiorespiratory fitness and four
categories of alcohol consumption, and the outcomes were all-cause and CVD mortality.
Cox proportional hazards regression was used to model the association between alcohol
intake, cardiorespiratory fitness, and all-cause and CVD mortality, controlling for
A total of 1830 (all-cause) and 523 (CVD) deaths occurred in men over an average follow-up
period of 17.4 years (SD=9.1). A linear relationship was observed (p<0.001) between increased fitness and reduced all-cause and CVD mortality. Specifically,
moderate and high levels of fitness reduced the risk for all-cause mortality (HR=0.67,
95% CI=0.60, 0.74, and HR=0.57, 95% CI=0.49, 0.67, respectively) and CVD mortality
in comparison to the low-fitness reference group (HR=0.70, 95% CI=0.57, 0.85; HR=0.54,
95% CI=0.40, 0.75, respectively), while controlling for alcohol intake and other covariates.
A significant curvilinear relationship was found (p=0.01) between alcohol intake and all-cause mortality (but not CVD mortality), while
controlling for fitness and other covariates. In a categoric examination of alcohol
intake and mortality, adjusting for fitness and other confounders, there was no statistically
significant effect of light drinking compared to heavy drinking on all-cause mortality
or CVD mortality. An examination of the joint effects of fitness and alcohol on all-cause
mortality showed that moderate and high fitness levels were protective against mortality
irrespective of alcohol consumption levels. Few significant combined effects for CVD
mortality reduction were found.
Alcohol consumption did not significantly modify the association between fitness and
mortality in this large cohort of men.