Association between physical activity and sub-types of cardiovascular disease death causes in a general population cohort

Abstract

Physical activity is thought to be cardioprotective, but associations with different subtypes of cardiovascular disease (CVD) are poorly understood. We examined associations between physical activity and seven major CVD death causes. The sample comprised 65,093 adults (aged 58 ± 12 years, 45.4% men) followed up over mean [SD] 9.4 ± 4.5 years, recruited from The Health Survey for England and the Scottish Health Surveys. A CVD diagnosis was reported in 9.2% of the sample at baseline. Physical activity was self-reported. Outcomes were subtypes of CVD death; acute myocardial infarction; chronic ischaemic heart disease; pulmonary heart disease; a composite of cardiac arrest, arrhythmias, and sudden cardiac death; heart failure; cerebrovascular; composite of aortic aneurysm and other peripheral vascular diseases. There were 3050 CVD deaths (30.8% of all deaths). In Cox proportional hazards models adjusted for confounders, physical activity was associated with reduced relative risk of all CVD outcomes; compared with the lowest, the highest physical activity quintile was associated with reduced risk of acute myocardial infarction (Hazard ratio 0.66: 95% CI 0.50, 0.89), chronic ischaemic heart disease (0.49: 0.38, 0.64), pulmonary heart disease (0.48: 0.22, 1.07), arrhythmias (0.18: 0.04, 0.76); heart failure (0.35: 0.20, 0.63), cerebrovascular events (0.53: 0.38, 0.75); aneurysm and peripheral vascular diseases (0.54: 0.34, 0.93). Results were largely consistent across participants with and without existing CVD at baseline. Physical activity was associated with reduced risk of seven major CVD death causes. Protective benefits were apparent even at levels of activity below the current recommendations. Electronic supplementary material The online version of this article (10.1007/s10654-018-0460-2) contains supplementary material, which is available to authorized users.

Physical activity and the risk of sudden cardiac death: a systematic review and meta-analysis of prospective studies

“…Six of the studies were from Europe and two were from the US and the duration of follow-up ranged from 6 to 26 years. One additional study from the United Kingdom reported on sudden cardiac death and arrhythmias combined and was included in a sensitivity analysis [32]. In addition, two studies on cardiorespiratory fitness were analyzed separately [22,23], and two studies on vigorous activity Fig.…”

“…A UK study which reported on sudden cardiac death and arrhythmias combined [32] was included with the eight other studies in a sensitivity analysis [9,12,[19][20][21]32] (n = 9 studies, 1263 events and 201,391 participants) and the summary RR was 0.51 (95% CI: 0.44-0.60, I 2 = 0%). Alternatively, using WHO recommendations for leisure-time physical activity categories from the study by Hamer et al [32], the summary RR was 0.52 (95% CI: 0.45-0.60, I 2 = 0%).…”

“…3b, Supplementary Table 2). The study by Hamer et al [32] was included in a sensitivity analysis [9,19,20,32] (651 events, 166,683 participants) and the summary RR per 20 MET-hours/week increase in physical activity was 0.66 (95% CI: 0.53-0.81, I 2 = 40%) ( Supplementary Figure 2a). The test for nonlinearity was not significant, p nonlinearity = 0.35, however, again the dose-response curve appeared largely flat from around 20-25 METhours/week and above ( Fig.…”

“…Physical activity was self-reported across studies thus some measurement error and misclassification of the exposure is likely to have occurred, however, because of the prospective design of the included studies, measurement errors would most likely have attenuated the observed associations. Only two studies specifically stated that the physical activity questionnaires had been validated [9,32]. The remaining studies only stated that they used a physical activity questionnaire or did not describe the physical activity assessment or whether it had been validated, possibly because physical activity was only one of many risk factors that were examined in relation to sudden cardiac death.…”

Inequalities in participation and time spent in moderate-to-vigorous physical activity: a pooled analysis of the cross-sectional health surveys for England 2008, 2012, and 2016

“…PASBAQ data is used to monitor adherence to UK PA recommendations [17,18] and for other epidemiological research [20,21]. The PASBAQ has demonstrated moderate-weak convergent validity in comparison with non-synchronous accelerometry [22].…”