In:
European Heart Journal Open, Oxford University Press (OUP)
Abstract:
To estimate the relation between physical exercise volume, type and intensity with all-cause mortality and recurrent vascular events in patients with cardiovascular disease (CVD), and to quantify to what extent traditional cardiovascular risk factors mediate these relations. Methods In the prospective UCC-SMART cohort (N=8,660), the associations of clinical endpoints and physical exercise volume (metabolic equivalent of task hours per week, METh/wk), type (endurance vs endurance + resistance) and intensity (moderate vs vigorous) were estimated using multivariable-adjusted Cox models. The proportion mediated effect (PME) through body mass index, systolic blood pressure, low-density lipoprotein cholesterol, insulin sensitivity and systemic inflammation was assessed using structural equation models. Results Sixty-one percent of patients (73% male, age 61±10 years, & gt;70% receiving lipid- and blood pressure-lowering medications), reported that they did not exercise. Over a median follow-up of 9.5 years [IQR 5.1-14.0], 2,256 deaths and 1,828 recurrent vascular events occurred. The association between exercise volume had a reverse J-shape with a nadir at 29 (95%CI 24-29) METh/wk, corresponding with a HR 0.56 (95%CI 0.48-0.64) for all-cause mortality and HR 0.63 (95%CI 0.55-0.73) for recurrent vascular events compared with no exercise. Up to 38% (95%CI 24-61) of the association was mediated through the assessed risk factors of which insulin sensitivity (PME up to 12%, 95%CI 5-25) and systemic inflammation (PME up to 18%, 95%CI 9-37) were the most important. Conclusion Regular physical exercise is significantly related with reduced risks of all-cause mortality and recurrent vascular events in patients with CVD. In this population with high rates of lipid- and blood-pressure lowering medication use, exercise benefits were mainly mediated through systemic inflammation and insulin resistance.
Type of Medium:
Online Resource
ISSN:
2752-4191
DOI:
10.1093/ehjopen/oead057
Language:
English
Publisher:
Oxford University Press (OUP)
Publication Date:
2023
detail.hit.zdb_id:
3112907-9
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