Longevity and reduced mortality and cardiovascular disease (CVD) mortality and morbidity compared with the general population are described among former athletes in a few studies only. The aim of the study was to assess the outcomes of mortality and CVD morbidity after 30 years follow-up in long-term cross country skiers. The study was based on three different age groups of 122 long-term long-endurance cross country skiers participating in studies in 1976 and 1981. A total of 78/85 skiers completed the 28–30 year follow-up, while 37 were dead. Causes of deaths through 2006 were ascertained using the National Death Register. Morbidity or mortality data were available in 115 subjects. Total deaths were 31% compared with 40% in the general male population (P=0.04). Exercise electrocardiographic ST-depression in 1981 was associated with the later appearance of coronary heart disease (HR 2.90; P=0.033). Body mass index and average systolic blood pressure from 1976 to 1981 were predictors of later appearance of CVD (HR 1.23; P=0.034 and HR 1.03; P=0.048, respectively). Long-term aerobic exercise appears to be associated with reduced all-cause mortality.