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Long-term Prognostic Impact of Physical Activity in Patients With Stable Coronary Heart Disease

Published:October 28, 2019DOI:https://doi.org/10.1016/j.amjcard.2019.10.017
      Stable coronary heart disease (CHD) patients are advised to practice regular physical activity (PA). However, data on very long-term prognosis impact of regular exercise remain scarce. We aimed to evaluate the impact of physical activity level on mortality at long term in stable CHD patients. We analyzed 822 patients with stable CHD. They answered questionnaires on medical history, underwent a standardized clinical examination, and provided a fasting blood sample. PA was evaluated by the MOSPA questionnaire. Three tertiles of patients were individualized according to PA level: 0.0-9 Metabolic Equivalent of Task (METs) hour per week (n = 267); 10-39.9 METs hour per week (n = 279); and ≥40 METs hour per week (n = 276). After a median follow-up of 14.6 years, 324 patients had died. In a multivariate analysis adjusted for age, dyslipidemia, smoking status, diabetes, high blood pressure, waist circumference, left ventricular ejection fraction, Gensini score, heart rate, ankle-brachial index and duration of disease, physical activity was significantly and independently associated with all-cause mortality. Compared to the lowest PA tertile, both the median and the highest PA tertiles, were associated to a reduction of all-cause mortality risk with hazard ratios at 0.79 (95%confidence interval [0.61:1.03], P = 0.08) and 0.71 ([0.53:0.96], P = 0.025) respectively; P for trend = 0.02. Adjusted hazard ratios for an increase of 10 METs hour per week was 0.95 [0.92 to 0.98], (P <0.002). In conclusion, our study demonstrates an independent association between PA and long term vital prognosis with a 5% total mortality decrease for an increase of 10 METs hour per week.
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      References

        • Task Force M
        • Montalescot G
        • Sechtem U
        • Achenbach S
        • Andreotti F
        • Arden C
        • Budaj A
        • Bugiardini R
        • Crea F
        • Cuisset T
        • Di Mario C
        • Ferreira JR
        • Gersh BJ
        • Gitt AK
        • Hulot JS
        • Marx N
        • Opie LH
        • Pfisterer M
        • Prescott E
        • Ruschitzka F
        • Sabate M
        • Senior R
        • Taggart DP
        • van der Wall EE
        • Vrints CJ
        • Zamorano JL
        • Achenbach S
        • Baumgartner H
        • Bax JJ
        • Bueno H
        • Dean V
        • Deaton C
        • Erol C
        • Fagard R
        • Ferrari R
        • Hasdai D
        • Hoes AW
        • Kirchhof P
        • Knuuti J
        • Kolh P
        • Lancellotti P
        • Linhart A
        • Nihoyannopoulos P
        • Piepoli MF
        • Ponikowski P
        • Sirnes PA
        • Tamargo JL
        • Tendera M
        • Torbicki A
        • Wijns W
        • Windecker S
        • Document R
        • Knuuti J
        • Valgimigli M
        • Bueno H
        • Claeys MJ
        • Donner-Banzhoff N
        • Erol C
        • Frank H
        • Funck-Brentano C
        • Gaemperli O
        • Gonzalez-Juanatey JR
        • Hamilos M
        • Hasdai D
        • Husted S
        • James SK
        • Kervinen K
        • Kolh P
        • Kristensen SD
        • Lancellotti P
        • Maggioni AP
        • Piepoli MF
        • Pries AR
        • Romeo F
        • Ryden L
        • Simoons ML
        • Sirnes PA
        • Steg PG
        • Timmis A
        • Wijns W
        • Windecker S
        • Yildirir A
        • Zamorano JL
        • Guidelines ESCCfP
        2013 ESC guidelines on the management of stable coronary artery disease: the task force on the management of stable coronary artery disease of the European Society of Cardiology.
        Eur Heart J. 2013; 34: 2949-3003
        • Fihn SD
        • Gardin JM
        • Abrams J
        • Berra K
        • Blankenship JC
        • Dallas AP
        • Douglas PS
        • Foody JM
        • Gerber TC
        • Hinderliter AL
        • King 3rd, SB
        • Kligfield PD
        • Krumholz HM
        • Kwong RY
        • Lim MJ
        • Linderbaum JA
        • Mack MJ
        • Munger MA
        • Prager RL
        • Sabik JF
        • Shaw LJ
        • Sikkema JD
        • Smith Jr., CR
        • Smith Jr., SC
        • Spertus JA
        • Williams SV
        • Anderson JL
        • American College of Cardiology Foundation/American Heart Association Task F
        2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons.
        Circulation. 2012; 126: e354-e471
        • O'Gara PT
        • Kushner FG
        • Ascheim DD
        • Casey Jr., DE
        • Chung MK
        • de Lemos JA
        • Ettinger SM
        • Fang JC
        • Fesmire FM
        • Franklin BA
        • Granger CB
        • Krumholz HM
        • Linderbaum JA
        • Morrow DA
        • Newby LK
        • Ornato JP
        • Ou N
        • Radford MJ
        • Tamis-Holland JE
        • Tommaso CL
        • Tracy CM
        • Woo YJ
        • Zhao DX
        • Anderson JL
        • Jacobs AK
        • Halperin JL
        • Albert NM
        • Brindis RG
        • Creager MA
        • DeMets D
        • Guyton RA
        • Hochman JS
        • Kovacs RJ
        • Kushner FG
        • Ohman EM
        • Stevenson WG
        • Yancy CW
        • American College of Cardiology Foundation/American Heart Association Task Force on Practice G
        2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.
        Circulation. 2013; 127: e362-e425
        • Anderson L
        • Oldridge N
        • Thompson DR
        • Zwisler AD
        • Rees K
        • Martin N
        • Taylor RS
        Exercise-based cardiac rehabilitation for coronary heart disease: cochrane systematic review and meta-analysis.
        J Am Coll Cardiol. 2016; 67: 1-12
        • Pouche M
        • Ruidavets JB
        • Ferrieres J
        • Iliou MC
        • Douard H
        • Lorgis L
        • Carrie D
        • Brunel P
        • Simon T
        • Bataille V
        • Danchin N
        Cardiac rehabilitation and 5-year mortality after acute coronary syndromes: the 2005 French FAST-MI study.
        Arch Cardiovasc Dis. 2016; 109: 178-187
        • Grau M
        • Bongard V
        • Fito M
        • Ruidavets JB
        • Sala J
        • Taraszkiewicz D
        • Masia R
        • Galinier M
        • Subirana I
        • Carrie D
        • Vila J
        • Marrugat J
        • Ferrieres J
        • Regicor GI
        Prevalence of cardiovascular risk factors in men with stable coronary heart disease in France and Spain.
        Arch Cardiovasc Dis. 2010; 103: 80-89
        • Bouisset F
        • Bongard V
        • Ruidavets JB
        • Hascoet S
        • Taraszkiewicz D
        • Roncalli J
        • Carrie D
        • Galinier M
        • Elbaz M
        • Ferrieres J
        Prognostic usefulness of clinical and subclinical peripheral arterial disease in men with stable coronary heart disease.
        Am J Cardiol. 2012; 110: 197-202
        • Genoux A
        • Ruidavets JB
        • Ferrieres J
        • Combes G
        • Lichtenstein L
        • Pons V
        • Laffargue M
        • Taraszkiewicz D
        • Carrie D
        • Elbaz M
        • Perret B
        • Martinez LO
        Serum IF1 concentration is independently associated to HDL levels and to coronary heart disease: the GENES study.
        J Lipid Res. 2013; 54: 2550-2558
        • Verdier C
        • Ruidavets JB
        • Bongard V
        • Taraszkiewicz D
        • Martinez LO
        • Elbaz M
        • Ferrieres J
        • Perret B
        Association of hepatic lipase -514T allele with coronary artery disease and ankle-brachial index, dependence on the lipoprotein phenotype: the GENES study.
        PLoS One. 2013; 8: e67805
        • Genoux A
        • Lichtenstein L
        • Ferrieres J
        • Duparc T
        • Bongard V
        • Vervueren PL
        • Combes G
        • Taraszkiewicz D
        • Elbaz M
        • Galinier M
        • Nassar B
        • Ruidavets JB
        • Perret B
        • Martinez LO
        Serum levels of mitochondrial inhibitory factor 1 are independently associated with long-term prognosis in coronary artery disease: the GENES Study.
        BMC Med. 2016; 14: 125
        • Martinez LO
        • Genoux A
        • Ferrieres J
        • Duparc T
        • Perret B
        Serum inhibitory factor 1, high-density lipoprotein and cardiovascular diseases.
        Curr Opin Lipidol. 2017; 28: 337-346
        • Verdier C
        • Ruidavets JB
        • Genoux A
        • Combes G
        • Bongard V
        • Taraszkiewicz D
        • Galinier M
        • Elbaz M
        • Ferrieres J
        • Martinez LO
        • Perret B
        Common p2y13 polymorphisms are associated with plasma inhibitory factor 1 and lipoprotein(a) concentrations, heart rate and body fat mass: the GENES study.
        Arch Cardiovasc Dis. 2019; 112: 124-134
        • Gensini GG
        A more meaningful scoring system for determining the severity of coronary heart disease.
        Am J Cardiol. 1983; 51: 606
        • Roeykens J
        • Rogers R
        • Meeusen R
        • Magnus L
        • Borms J
        • de Meirleir K
        Validity and reliability in a Flemish population of the WHO-MONICA Optional Study of Physical Activity Questionnaire.
        Med Sci Sports Exerc. 1998; 30: 1071-1075
        • Pereira MA
        • FitzerGerald SJ
        • Gregg EW
        • Joswiak ML
        • Ryan WJ
        • Suminski RR
        • Utter AC
        • Zmuda JM
        A collection of Physical Activity Questionnaires for health-related research.
        Med Sci Sports Exerc. 1997; 29: S1-205
        • Wannamethee SG
        • Shaper AG
        • Walker M
        Physical activity and mortality in older men with diagnosed coronary heart disease.
        Circulation. 2000; 102: 1358-1363
        • Janssen I
        • Jolliffe CJ
        Influence of physical activity on mortality in elderly with coronary artery disease.
        Med Sci Sports Exerc. 2006; 38: 418-427
        • Apullan FJ
        • Bourassa MG
        • Tardif JC
        • Fortier A
        • Gayda M
        • Nigam A
        Usefulness of self-reported leisure-time physical activity to predict long-term survival in patients with coronary heart disease.
        Am J Cardiol. 2008; 102: 375-379
        • Stewart RAH
        • Held C
        • Hadziosmanovic N
        • Armstrong PW
        • Cannon CP
        • Granger CB
        • Hagstrom E
        • Hochman JS
        • Koenig W
        • Lonn E
        • Nicolau JC
        • Steg PG
        • Vedin O
        • Wallentin L
        • White HD
        • Investigators S
        Physical activity and mortality in patients with stable coronary heart disease.
        J Am Coll Cardiol. 2017; 70: 1689-1700
        • Moholdt T
        • Lavie CJ
        • Nauman J
        Sustained physical activity, not weight loss, associated with improved survival in coronary heart disease.
        J Am Coll Cardiol. 2018; 71: 1094-1101
        • Long L
        • Mordi IR
        • Bridges C
        • Sagar VA
        • Davies EJ
        • Coats AJ
        • Dalal H
        • Rees K
        • Singh SJ
        • Taylor RS
        Exercise-based cardiac rehabilitation for adults with heart failure.
        Cochrane Database Syst Rev. 2019; 1 (CD003331)
        • Belardinelli R
        • Georgiou D
        • Cianci G
        • Purcaro A
        10-year exercise training in chronic heart failure: a randomized controlled trial.
        J Am Coll Cardiol. 2012; 60: 1521-1528
        • Lahtinen M
        • Toukola T
        • Junttila MJ
        • Piira OP
        • Lepojarvi S
        • Kaariainen M
        • Huikuri HV
        • Tulppo MP
        • Kiviniemi AM
        Effect of changes in physical activity on risk for cardiac death in patients with coronary artery disease.
        Am J Cardiol. 2018; 121: 143-148