This study by Laukkanen et al was designed to examine the association of cardiovascular fitness, as measured by maximal oxygen uptake, with overall cardiovascular and noncardiovascular disease mortality. The sample was 1294 randomly selected men in eastern Finland who had no cardiovascular disease, pulmonary disease, or cancer at the initiation of the study. During an average follow-up of 10.7 years, there were 124 overall deaths (42 from cardiovascular disease, 82 from noncardiovascular disease). The relative risk results did not change even when taking into account smoking habits, alcohol consumption, serum lipid profile, blood pressure, plasma fibrinogen, diabetes, and fasting serum insulin. Furthermore, the risk of cardiovascular and noncardiovascular disease-related death was the same as the risk of overall death. Low maximal oxygen uptake was as strong a risk factor as conventional risk factors for death, including elevated systolic blood pressure, smoking, obesity, and diabetes. This finding emphasizes the importance of low cardiovascular fitness as a risk factor for death. In this study, low cardiovascular fitness represents one of the strongest predictors of mortality.