Kristian Engeseth’s PhD thesis follows healthy men for up to 35 years and looks at how physical fitness and heart rate reserve predict risk of all-cause and cardiovascular death.


  1. Low heart rate reserve predicts cardiovascular death in the long term.
  2. Ability to increase heart rate during exercise can reveal cardiovascular risk.
  3. Change in physical fitness predicts long-term mortality.


Thesis: Long-Term Predictors of Cardiovascular Disease (CVD) and CVD Related Mortality in Healthy Middle-Aged Norwegian Men
Candidate: Kristian Engeseth
Time: June 12, 2019 at 12:15
Place: Oslo University Hospital Ullevål, Laboratoriebygget: Red Auditorium
Link to university website


(1) Unfit, but otherwise healthy men are at 70 % increased risk of dying from cardiovascular disease if they have a low heart rate reserve. In moderately fit and fit men, there is no association between heart rate reserve and long-term cardiovascular risk.

The analyses include data from more than 2000 healthy men aged between 40 and 59 years who took part in a study in Oslo between 1972 and 1975. By 2007, 754 of them developed and 528 died from cardiovascular diseases. The risk of cardiovascular death in the least fit third of the men was increased with 70 % if they had low heart rate reserve, and the risk of cardiovascular disease was increased with 39 % .

(2) Middle-aged men who decrease their ability to increase the heart rate during exercise over time, have increased 20-year risk of dying from cardiovascular disease. 1420 of the healthy men took part in new tests seven years after the first tests in 1972-75. By 2007, 740 of the men had died, of which 310 died from cardiovascular disease. The fourth of the men with the greatest reduction in chronotropic index between the tests had 50 % and 35 % increased risk of cardiovascular and all-cause mortality, respectively, compared to the quartile who increased their chronotropic index between the tests.

(3) High fitness in mid-life predicts long-term protection from cardiovascular disease. Engeseth and co-workers used the results from the two fitness test seven years apart in the 1420 healthy men to study associations between fitness, change in fitness and all-cause and cardiovascular mortality. The men were followed until 2007.

The least fit men at the first test had 60 % increased mortality compared to the fittest quartile. Fitness was also linked to the risk of dying from cardiovascular disease, but only during the first part of the follow-up period. However, change in fitness over time predicted both cardiovascular and all-cause death in the long term, with the lowest risk in those who improved their fitness between the two tests.


(1) Engeseth, K., Hodnesdal, C., Grundvold, I., Liestøl, K., Gjesdal, K., Erikssen, G., Kjeldsen, S. E., Erikssen, J. E., Bodegard, J., & Skretteberg, P. T. (2016). Heart rate reserve predicts cardiovascular death among physically unfit but otherwise healthy middle-aged men: a 35-year follow-up studyEuropean journal of preventive cardiology23(1), 59-66.

(2) Engeseth, K., Hodnesdal, C., Grundvold, I., Liestøl, K., Gjesdal, K., Kjeldsen, S. E., Erikssen, J. E., Bodegard, J., & Skretteberg, P. T. (2016). Temporal Reduction in Chronotropic Index Predicts Risk of Cardiovascular Death Among Healthy Middle‐Aged Men: a 28‐Year Follow‐Up StudyJournal of the American Heart Association5(12), e004555.

(3) Engeseth, K., Prestgaard, E. E., Mariampillai, J. E., Grundvold, I., Liestol, K., Kjeldsen, S. E., Bodegard, J., Erikssen, J. E., Gjesdal, K. & Skretteberg, P. T. (2018). Physical fitness is a modifiable predictor of early cardiovascular death: A 35-year follow-up study of 2014 healthy middle-aged men. European journal of preventive cardiology25(15), 1655-1663.

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