European journal of preventive cardiology最新文献

Objectives: The association between physical activity and venous thromboembolism (VTE) remains unclear. Therefore, we investigated the prospective dose-response associations between accelerometer-measured intensity-specific physical activity and new-onset VTE, accounting for genetic risk.

Methods and results: In total, 85 116 participants from the UK Biobank were included. Incident VTE was identified via linked hospital records and death registries. A weighted polygenic risk score (PRS) was used to quantify genetic risk for VTE, with higher values indicating a high genetic risk. Cox proportional hazard models were used to calculate the hazard ratios (HRs) and 95% confidence intervals (95% CIs) of the associations. Overall, 1182 incident VTE cases were documented during a median follow-up of 6.18 years. In the overall study population, the participants in the highest level of the total volume of physical activity [0.60 (0.45, 0.79)], moderate-to-vigorous-intensity physical activity [0.66 (0.51, 0.86)], and light-intensity physical activity [0.66 (0.51, 0.85)] had lower adjusted HRs (95% CIs) for VTE than those of participants in the lowest level. Both the total volumes of physical activity and light-intensity physical activity were negatively associated with VTE risk in participants with low, intermediate, and high PRS. However, moderate-to-vigorous-intensity physical activity was only protective against VTE in participants with low and intermediate PRS, with a significant interaction (P for interaction = 0.02).

Conclusion: Higher levels of physical activity of any intensity were associated with a lower risk of new-onset VTE. However, the negative association between moderate-to-vigorous-intensity physical activity and new-onset VTE was significant only in participants with low and intermediate genetic predispositions to VTE.

Aims: Chronotropic incompetence and impaired heart rate (HR) recovery are related to mortality. Guidelines lack specific reference values for HR recovery. We defined normal values and studied blunted HR response and recovery and mortality risk.

Methods and results: We included 9917 subjects (45% females) aged 18-85 years who performed a cycle exercise test. We defined normal values for peak HR, HR reserve, and HR recovery at 1 and 2 min (HRR1 and HRR2) based on individuals apparently healthy (N = 2242). Associations between blunted HR indices (<5th percentile) and mortality over a median follow-up of 8.6 years were analysed using Cox regression and competing risk analysis. All HR indices were age-dependent and independent predictors of all-cause and cardiovascular (CV) mortality. The 5th percentiles of HR reserve, HRR1, and HRR2 correlated weakly with existing reference values. Heart rate recovery variables were the strongest predictors of all-cause mortality in both the overall population [HRR1, hazard ratio 1.70 (95% confidence interval, 1.49-1.94), and HRR2, 1.57 (1.37-1.79)] and in subjects with normal exercise capacity [HRR1, 1.96 (1.61-2.39), and HRR2, 1.76 (1.46-2.12)]. Combining HR indices appeared to increase the risk of all-cause [HRR1 and HRR2, 1.96 (1.68-2.29), and peak HR and HRR1, 1.87 (1.56-2.23)] and CV mortality, although no specific combination was superior for predicting CV mortality.

Conclusion: All HR indices were age-dependent and associated with all-cause and CV mortality. Blunted HR recovery variables were the strongest predictors of all-cause mortality, even in subjects with normal exercise capacity. Combined blunted HR indices appeared to add prognostic value.

Aims: To investigate the association of accelerometer-measured intensity-specific physical activity (PA) with all-cause and cause-specific mortality among individuals with cardiovascular disease (CVD).

Methods and results: In this prospective cohort study, 8024 individuals with pre-existing CVD (mean age: 66.6 years, female: 34.1%) from the UK Biobank had their PA measured using wrist-worn accelerometers over a 7-day period in 2013-2015. All-cause, cancer, and CVD mortality was ascertained from death registries. Cox regression modelling and restricted cubic splines were used to assess the associations. Population-attributable fractions (PAFs) were used to estimate the proportion of preventable deaths if more PA was undertaken. During a median follow-up of 6.8 years, 691 deaths (273 from cancer and 219 from CVD) were recorded. An inverse non-linear association was found between PA duration and all-cause mortality risk, irrespective of PA intensity. The hazard ratio (HR) of all-cause mortality plateaued at 1800 min/week for light-intensity PA (LPA), 320 min/week for moderate-intensity PA (MPA), and 15 min/week for vigorous-intensity PA (VPA). The highest quartile of PA was associated with lower risks for all-cause mortality, with HRs of 0.63 (95% confidence interval [CI]: 0.51-0.79), 0.42 (0.33-0.54), and 0.47 (0.37-0.60) for LPA, MPA, and VPA, respectively. Similar associations were observed for cancer and CVD mortality. Additionally, the highest PAFs were noted for VPA, followed by MPA.

Conclusion: We found an inverse non-linear association between all intensities of PA (LPA, MPA, VPA, and MVPA) and mortality risk in CVD patients using accelerometer-derived data, but with a larger magnitude of the associations than that in previous studies based on self-reported PA.

Aims: Blood pressure (BP) responses to exercise are frequently measured, with the concern that greater increases are a marker of disease. We sought to characterize the normal exercise BP response in healthy adults and its relationships with age, sex, and fitness.

Methods and results: Five hundred and eighty-nine participants [median age 46 (interquartile range 24-56) years, 81% male] underwent cardiopulmonary exercise testing with repeated, automated BP measures. An exaggerated maximal systolic BP (SBPmax) was defined from current guidelines as ≥210 mmHg in males and ≥190 mmHg in females. Individual linear regression analyses defined the relationship between BP and workload (W; SBP/W-slope and DBP/W-slope). Participants with or without an exaggerated SBPmax and above- or below-median SBP/W-slope were compared. An exaggerated SBPmax was found in 51% of males and 64% of females and was more prevalent in endurance-trained athletes (males 58%, females 72%, P < 0.001). The mean SBP/W-slope was lower in males (0.24 ± 0.10 mmHg/W) than females (0.27 ± 0.12 mmHg/W, P = 0.031). In both sexes, peak oxygen uptake (VO2peak) was inversely correlated with SBP/W-slope (P < 0.01). Those with an exaggerated SBPmax and below-median SBP/W-slope were 10 years younger and had a 20% higher VO2peak, on average (P < 0.001). A non-exaggerated SBPmax and above-median SBP/W-slope was observed in older individuals with the lowest VO2peak.

Conclusion: In a large cohort of healthy individuals, an exaggerated SBPmax was common and associated with higher fitness. In contrast, higher SBP indexed to W was associated with older age, lower fitness, and female sex. Thus, sex, age, and fitness should be considered when evaluating BP response to exercise.

Registration: Pro@Heart: NCT05164328, ACTRN12618000716268; ProAFHeart: ACTRN12618000711213; Master@Heart: NCT03711539.