التفاصيل البيبلوغرافية
| العنوان: |
Physical exercise volume, type, and intensity and risk of all-cause mortality and cardiovascular events in patients with cardiovascular disease: a mediation analysis. |
| المؤلفون: |
Bonekamp, Nadia E, May, Anne M, Halle, Martin, Dorresteijn, Jannick A N, van der Meer, Manon G, Ruigrok, Ynte M, de Borst, Gert J, Geleijnse, Johanna M, Visseren, Frank L J, Koopal, Charlotte |
| المصدر: |
European Heart Journal Open; May2023, Vol. 3 Issue 3, p1-10, 10p |
| مصطلحات موضوعية: |
MORTALITY, CARDIOVASCULAR diseases, CARDIOVASCULAR diseases risk factors, SYSTOLIC blood pressure, LDL cholesterol |
| مستخلص: |
Aims: 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 and results: In the prospective UCC-SMART cohort (N = 8660), 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. Sixty-one percent of patients (73% male, age 61 ± 10 years, >70% receiving lipid-lowering and blood pressure–lowering medications) reported that they did not exercise. Over a median follow-up of 9.5 years [interquartile range (IQR) 5.1–14.0], 2256 deaths and 1828 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-lowering and blood pressure-–lowering medication use, exercise benefits were mainly mediated through systemic inflammation and insulin resistance. Lay Summary: People that have previously experienced cardiovascular events, like a heart attack or stroke, are at lower risk of a recurrent event or mortality when they regularly perform physical exercise because exercise beneficially affects cardiovascular risk factors. Time spent on exercise is the most important determinant of exercise benefits; similar cardiovascular benefits can be achieved with different exercise types and intensities. It is important to choose an exercise modality that suits personal preferences and abilities, as any level of exercise is better than no exercise. In the context of well-treated CVD patients, exercise benefits come about through beneficial modification of cardiovascular risk factors, most importantly inflammation and insulin sensitivity. Graphical Abstract [ABSTRACT FROM AUTHOR] |
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| قاعدة البيانات: |
Complementary Index |
