Premorbid physical activity and prognosis after incident myocardial infarction: The atherosclerosis risk in communities study

IF 3.7 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS American heart journal Pub Date : 2024-05-07 DOI:10.1016/j.ahj.2024.05.005

Yejin Mok PhD,MPH , Yifei Lu PhD , Shoshana H. Ballew PhD , Yingying Sang MS , Anna Kucharska-Newton PhD,MPH , Mauro F. Mediano PhD , Silvia Koton PhD , Jennifer A. Schrack PhD , Priya Palta PhD , Josef Coresh MD,PhD , Wayne Rosamond PhD , Kunihiro Matsushita MD,PhD

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Abstract

Background

High to moderate levels of physical activity (PA) are associated with low risk of incident cardiovascular disease. However, it is unclear whether the benefits of PA in midlife extend to cardiovascular health following myocardial infarction (MI) in later life.

Methods

Among 1,111 Atherosclerosis Risk in Communities study participants with incident MI during Atherosclerosis Risk in Communities follow-up (mean age 73 [SD 9] years at MI, 54% men, 21% Black), PA on average 11.9 (SD 6.9) years prior to incident MI (premorbid PA) was evaluated as the average score of PA between visit 1 (1987-1989) and visit 3 (1993-1995) using a modified Baecke questionnaire. Total and domain-specific PA (sport, nonsport leisure, and work PA) was analyzed for associations with composite and individual outcomes of mortality, recurrent MI, and stroke after index MI using multivariable Cox models.

Results

During a median follow-up of 4.6 (IQI 1.0-10.5) years after incident MI, 823 participants (74%) developed a composite outcome. The 10-year cumulative incidence of the composite outcome was lower in the highest, as compared to the lowest tertile of premorbid total PA (56% vs. 70%, respectively). This association remained statistically significant even after adjusting for potential confounders (adjusted hazard ratio [aHR] 0.80 [0.67-0.96] for the highest vs. lowest tertile). For individual outcomes, high premorbid total PA was associated with a low risk of recurrent MI (corresponding aHR 0.64 [0.44, 0.93]). When domain-specific PA was analyzed, similar results were seen for sport and work PA. The association was strongest in the first year following MI (e.g., aHR of composite outcome 0.66 [95% CI 0.47, 0.91] for the highest vs. lowest tertile of total PA).

Conclusions

Premorbid PA was associated positively with post-MI cardiovascular health. Our results demonstrate the additional prognostic advantages of PA beyond reducing the risk of incident MI.

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病前体力活动与心肌梗死后的预后：社区动脉粥样硬化风险研究。

背景：中高水平的体力活动（PA）与心血管疾病的低发病风险有关。然而，目前还不清楚中年时进行体育锻炼的益处是否会延伸到晚年心肌梗塞（MI）后的心血管健康：在 ARIC 随访期间发生心肌梗死的 111 名 ARIC 参与者中（发生心肌梗死时平均年龄为 73 [SD 9] 岁，54% 为男性，21% 为黑人），使用改良的 Baecke 问卷对发生心肌梗死前平均 11.9（SD 6.9）年的 PA（病前 PA）进行了评估，即访问 1（1987-89 年）至访问 3（1993-95 年）期间 PA 的平均得分。使用多变量 Cox 模型分析了总 PA 和特定领域 PA（运动、非运动休闲和工作 PA）与指数心肌梗死后死亡率、复发性心肌梗死和中风的综合和个体结果的关系：在发生心肌梗死后中位随访 4.6（IQI 1.0-10.5）年期间，823 名参与者（74%）出现了综合结果。与病前总PA值最低的三等分位数相比，病前总PA值最高的三等分位数的10年累积综合结果发生率较低（分别为56%和70%）。即使在调整了潜在的混杂因素后，这种关联仍具有统计学意义（最高三分位数与最低三分位数的调整后危险比 [aHR] 为 0.80 [0.67-0.96]）。就单个结果而言，病前总PA高与复发性心肌梗死的低风险相关（相应的aHR为0.64 [0.44, 0.93]）。在分析特定领域的 PA 时，运动 PA 和工作 PA 的结果相似。在心肌梗死后的第一年，这种关联性最强（例如，总PA最高与最低三分位数的综合结果aHR为0.66 [95% CI 0.47, 0.91]）：结论：病前 PA 与心肌梗死后的心血管健康呈正相关。我们的研究结果表明，除了降低发生心肌梗死的风险外，PA 还具有额外的预后优势。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American heart journal 医学-心血管系统

CiteScore

8.20

自引率

2.10%

发文量

214

审稿时长

38 days

期刊介绍： The American Heart Journal will consider for publication suitable articles on topics pertaining to the broad discipline of cardiovascular disease. Our goal is to provide the reader primary investigation, scholarly review, and opinion concerning the practice of cardiovascular medicine. We especially encourage submission of 3 types of reports that are not frequently seen in cardiovascular journals: negative clinical studies, reports on study designs, and studies involving the organization of medical care. The Journal does not accept individual case reports or original articles involving bench laboratory or animal research.