Sex Differences in Physical Activity and Its Association With Cardiac Death and All-Cause Mortality in Patients With Implantable Cardioverter-Defibrillators

Abstract

Objective: To clarify the impact of sex on physical activity (PA) levels among patients with implantable cardioverter-defibrillators/cardiac resynchronization therapy defibrillators (ICD/CRT-D) and its association with cardiac death and all-cause mortality.Methods: Overall, data of 820 patients with ICD/CRT-D from the SUMMIT registry were retrospectively analyzed. Baseline PA from 30 to 60 days after device implantation was measured using Biotronik accelerometer sensors. The primary and secondary endpoints were cardiac death and all-cause mortality, respectively.Results: Baseline PA levels were significantly higher in male patients than in female patients (11.40 ± 5.83% vs. 9.93 ± 5.49%, P = 0.001). Males had higher predictive PA cut-off values for cardiac death (11.16 vs. 7.15%) and all-cause mortality (11.33 vs. 7.17%). During the median follow-up time of 75.7 ± 29.1 months, patients with baseline PA<cut-off values had higher cumulative incidence of cardiac death and all-cause mortality in both males and females. At a PA level between the cut-off values of males and females, males had a higher risk of cardiac death (hazard ratio = 4.952; 95%CI = 1.055-23.245, P = 0.043) and all-cause mortality (hazard ratio = 2.432; 95%CI = 1.095-5.402, P = 0.029).Conclusions: Males had higher predictive PA cut-off values for cardiac death and all-cause mortality in patients with ICD/CRT-D. Sex should be considered as an important contributing factor when deciding for PA targets.

Exploring the association of physical activity with the plasma and urine metabolome in adolescents and young adults

“…Several studies have highlighted sex-differences in not only exercise habits and intensity [ 2 , 38 , 39 , 66 ] but also within the phenotype of physiological systems and responses to exercise [ 67 , 68 ]. Sex-differences in metabolite concentrations have also been described [ 40 – 42 ].…”

“…Participants’ characteristics were summarized using median with 25% and 75% percentile for continuous variables and count (percentage) for categorical variables. All data processing and downstream analyses were sex-stratified because of the well-established sex differences in physical activity levels and intensity [ 2 , 38 , 39 ], human metabolome [ 40 – 42 ] and the interrelationship between some metabolites such as tryptophan [ 43 ]. As a data processing step, we excluded metabolites with more than 20% missing values as per the “80% rule” described in [ 44 ].…”

“…A large body of evidence emphasizes health benefits of physical activity and an active lifestyle, from early childhood through adolescence into adulthood. High level of physical activity has been associated with lower risk of cardiovascular diseases [ 1 , 2 ], type 2 diabetes and metabolic syndrome [ 3 , 4 ], all-cause mortality [ 1 , 2 , 5 ] and mental disorders [ 6 ]. The effect of physical activity on the immediate fuel utilization through aerobic and anaerobic metabolism is well elucidated [ 7 ].…”

The Appropriateness of Medical Devices Is Strongly Influenced by Sex and Gender

“…Although some data suggested a lower efficiency of these devices in women, recent data performed with a large number of women show that women and men have similar outcomes, even if more symptoms of advanced heart failure are more present in women than in men [167]. Interestingly, physical activity is higher in men than in women, in patients with a ICD/CRT-D [172][173][174][175]. However, other authors evidenced comparable outcomes in both women and men [176,177].…”