Nathalia Gonzalez-Jaramillo1, Matthias Wilhelm2, Ana María Arango-Rivas3, Valentina Gonzalez-Jaramillo4, Cristina Mesa-Vieira4, Beatrice Minder5, Oscar H Franco6, Arjola Bano7. 1. University of Bern, Institute of Social and Preventive Medicine, Bern, Switzerland; Graduate School for Health Sciences, University of Bern, Bern, Switzerland; Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. Electronic address: nathalia.gonzalez@ispm.unibe.ch. 2. Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. 3. Faculty of Medicine, Universidad Pontificia Bolivariana, Medellín, Colombia. 4. University of Bern, Institute of Social and Preventive Medicine, Bern, Switzerland; Graduate School for Health Sciences, University of Bern, Bern, Switzerland. 5. Public Health and Primary Care Library, University Library of Bern, University of Bern, Bern, Switzerland. 6. University of Bern, Institute of Social and Preventive Medicine, Bern, Switzerland. 7. University of Bern, Institute of Social and Preventive Medicine, Bern, Switzerland; Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. Electronic address: arjola.bano@ispm.unibe.ch.
Abstract
BACKGROUND: The role of lifestyle physical activity (PA) trajectories in the mortality risk of patients with coronary heart disease (CHD) remains unclear. OBJECTIVES: The purpose of this study was to determine the association of longitudinal PA trajectories with all-cause and cardiovascular disease (CVD) mortality in patients with CHD. METHODS: Longitudinal cohorts reporting the association of PA trajectories with mortality in patients with CHD were identified in April 2021 by searching 5 databases without language restrictions. Published HRs and 95% CIs were pooled using random effects models and bias assessed by Egger regression. RESULTS: A total of 9 prospective cohorts included 33,576 patients. The mean age was 62.5 years. The maximum follow-up was 15.7 years. All of the studies assessed PA through validated questionnaires, and mortality was well documented. Changes in PA defined 4 nominal PA trajectories. Compared with always-inactive patients, the risk of all-cause mortality was 50% lower in those who remained active (HR: 0.50; 95% CI: 0.39-0.63); 45% lower in those who were inactive but became active (HR: 0.55; 95% CI: 0.44-0.7); and 20% lower in those who were active but became inactive (HR: 0.80; 95% CI: 0.64-0.99). Similar results were observed for CVD mortality, except for the category of decreased activity (HR: 0.91; 95% CI: 0.67-1.24). The overall risk of bias was low. No evidence of publication bias was found. Multiple sensitivity analyses provided consistent results. CONCLUSIONS: This study illustrates how patients with CHD may benefit by preserving or adopting an active lifestyle. The observation that the benefits of past activity can be weakened or lost if PA is not maintained may be confounded by disease progression.
BACKGROUND: The role of lifestyle physical activity (PA) trajectories in the mortality risk of patients with coronary heart disease (CHD) remains unclear. OBJECTIVES: The purpose of this study was to determine the association of longitudinal PA trajectories with all-cause and cardiovascular disease (CVD) mortality in patients with CHD. METHODS: Longitudinal cohorts reporting the association of PA trajectories with mortality in patients with CHD were identified in April 2021 by searching 5 databases without language restrictions. Published HRs and 95% CIs were pooled using random effects models and bias assessed by Egger regression. RESULTS: A total of 9 prospective cohorts included 33,576 patients. The mean age was 62.5 years. The maximum follow-up was 15.7 years. All of the studies assessed PA through validated questionnaires, and mortality was well documented. Changes in PA defined 4 nominal PA trajectories. Compared with always-inactive patients, the risk of all-cause mortality was 50% lower in those who remained active (HR: 0.50; 95% CI: 0.39-0.63); 45% lower in those who were inactive but became active (HR: 0.55; 95% CI: 0.44-0.7); and 20% lower in those who were active but became inactive (HR: 0.80; 95% CI: 0.64-0.99). Similar results were observed for CVD mortality, except for the category of decreased activity (HR: 0.91; 95% CI: 0.67-1.24). The overall risk of bias was low. No evidence of publication bias was found. Multiple sensitivity analyses provided consistent results. CONCLUSIONS: This study illustrates how patients with CHD may benefit by preserving or adopting an active lifestyle. The observation that the benefits of past activity can be weakened or lost if PA is not maintained may be confounded by disease progression.
Authors: Prisca Eser; Nathalia Gonzalez-Jaramillo; Selina Weber; Jan Fritsche; Riccardo Femiano; Charlotte Werner; Flurina Casanova; Arjola Bano; Oscar H Franco; Matthias Wilhelm Journal: Front Cardiovasc Med Date: 2022-09-28
Authors: Nathalia Gonzalez-Jaramillo; Prisca Eser; Flurina Casanova; Arjola Bano; Oscar H Franco; Stephan Windecker; Lorenz Räber; Matthias Wilhelm Journal: Front Cardiovasc Med Date: 2022-09-30