A moderate-to-high level of physical activity was associated with a lower risk of instant and 28-day death in relation to a myocardial infarction, found a large study in European Journal of Preventative Cardiology.
Heart disease is the leading cause of death globally and prevention is a major public health priority. The beneficial impact of physical activity in stopping heart disease and sudden death on a population level is well documented. This study focused on the effect of an active versus sedentary lifestyle on the immediate course of a heart attack – an area with little information.
The researchers used data from 10 European observational cohorts including healthy participants with a baseline assessment of physical activity who had a heart attack during follow-up – a total of 28,140 individuals. Participants were categorised according to their weekly level of leisure-time physical activity as sedentary, low, moderate, or high.
The association between activity level and the risk of death due to a heart attack (instantly and within 28 days) was analysed in each cohort separately and then the results were pooled. The analyses were adjusted for age, sex, diabetes, blood pressure, family history of heart disease, smoking, body mass index, blood cholesterol, alcohol consumption, and socioeconomic status.
A total of 4,976 (17.7%) participants died within 28 days of their heart attack – of these, 3,101 (62.3%) died instantly. Overall, a higher level of physical activity was associated with a lower risk of instant and 28-day fatal heart attack, seemingly in a dose-response-like manner. Patients who had engaged in moderate and high levels of leisure-time physical activity had a 33% and 45% lower risk of instant death compared to sedentary individuals. At 28 days these numbers were 36% and 28%, respectively. The relationship with low activity did not reach statistical significance.
Study author Dr Kim Wadt Hansen of Bispebjerg Hospital – Copenhagen, Denmark said: "Almost 18% of patients with a heart attack died within 28 days, substantiating the severity of this condition. We found an immediate survival benefit of prior physical activity in the setting of a heart attack, a benefit which seemed preserved at 28 days."
He noted: "Based on our analyses, even a low amount of leisure-time physical activity may in fact be beneficial against fatal heart attacks, but statistical uncertainty precludes us from drawing any firm conclusions on that point."
The authors said in the paper: "Our pooled analysis provides strong support for the recommendations on weekly physical activity in healthy adults stated in the 2016 European Guidelines on cardiovascular disease prevention in clinical practice; especially as we used cut-off values for physical activity comparable to those used in the guidelines."
The guidelines recommend that healthy adults of all ages perform at least 150 minutes a week of moderate intensity or 75 minutes a week of vigorous intensity aerobic physical activity or an equivalent combination thereof.
Hansen concluded: "There are many ways to be physically active at little or no cost. Our study provides yet more evidence for the rewards of exercise."
Association of fatal myocardial infarction with past level of physical activity: a pooled analysis of cohort studies
Kim Wadt Hansen, Nina Peytz, Anneke Blokstra, Stig E Bojesen, Carlos Celis-Morales, Christina Chrysohoou, Els Clays, Dirk De Bacquer, Søren Galatius, Stuart R Gray, Frederick Ho, Maryam Kavousi, Chantal M Koolhaas, Matina Kouvari, Maja-Lisa Løchen, Pedro Marques-Vidal, Merete Osler, Demosthenes Panagiotakos, Jill P Pell, Gerhard Sulo, Grethe S Tell, Vassilios Vassiliou, W M Monique Verschuren, Eva Prescott
Published in the European Journal of Preventative Cardiology on 10 February 2021
To assess the association between past level of physical activity (PA) and risk for death during the acute phase of myocardial infarction (MI) in a pooled analysis of cohort studies.
Methods and results
European cohorts including participants with a baseline assessment of PA, conventional cardiovascular (CV) risk factors, and available follow-up on MI and death were eligible. Patients with an incident MI were included. Leisure-time PA was grouped as sedentary (<7 MET-hours), low (7–16 MET-hours), moderate (16.1–32 MET-hours), or high (>32 MET-hours) based on calculated net weekly energy expenditure. The main outcome measures were instant and 28-day case fatality of MI. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using multivariate random-effects models. Adjustments for age, sex, CV risk factors, alcohol consumption, and socioeconomic status were made. From 10 cohorts including a total of 1 495 254 participants, 28 140 patients with an incident MI comprised the study population. A total of 4976 (17.7%) died within 28 days—of these 3101 (62.3%) were classified as instant fatal MI. Compared with sedentary individuals, those with a higher level of PA had lower adjusted odds of instant fatal MI: low PA [OR, 0.79 (95% CI, 0.60–1.04)], moderate PA [0.67 (0.51–0.89)], and high PA [0.55 (0.40–0.76)]. Similar results were found for 28-day fatal MI: low PA [0.85 (0.71–1.03)], moderate PA [0.64 (0.51–0.80)], and high PA [0.72 (0.51–1.00)]. A low-to-moderate degree of heterogeneity was detected in the analysis of instant fatal MI (I2 = 47.3%), but not in that of 28-day fatal MI (I2 = 0.0%).
A moderate-to-high level of PA was associated with a lower risk of instant and 28-day death in relation to a MI.
European Society of Cardiology material
European Journal of Preventive Cardiology study (Open access)
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