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Increased exercise reduces mortality risk in CHD
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Increased physical activity was linked to reduced mortality risk in patients with stable CHD, according to a study published in the Journal of the American College of Cardiology.
Ralph A. H. Stewart, MD, of the Green Lane Cardiovascular Service at Auckland City Hospital in New Zealand, and colleagues analyzed data from 15,486 participants (mean age, 65 years; 19% women) with chronic stable CHD from the STABILITY trial who completed a lifestyle questionnaire on physical activity. The Age, Biomarkers, Clinical-CHD (ABC-CHD) risk score was calculated to estimate overall CHD risk.
All-cause mortality was the primary endpoint. Secondary endpoints included stroke, MI, non-CV mortality, CV death and major adverse coronary events, which was defined as the first occurren of stroke or CV death.
Participants with increased habitual exercise had a graded decrease in total CV and non-CV mortality, which was steeper at lower exercise levels vs. higher levels.
Those who doubled exercise volume had a reduced rate of all-cause mortality (HR = 0.82; 95% CI, 0.79-0.85), which was similar after adjusting for covariates (HR = 0.9; 95% CI, 0.87-0.93). Doubling exercise volume also reduced the incidence of CV (HR = 0.83; 95% CI, 0.8-0.87; HR = 0.92; 95% CI, 0.88-0.96).
The risk MI and stroke were not linked to exercise volume after adjusting for covariates.
Patients at higher risk according to the ABC-CHD risk score had a stronger association between greater physical activity and decreased mortality (P = .0007).
“At a population level, the greatest benefits to health are likely to be achieved by modest increases in exercise in sedentary persons, especially in persons who have a higher risk of adverse events and those with exertional angina and dyspnea,” Stewart and colleagues wrote. “However, because low physical activity may reflect poorer health, randomized clinical trials are still needed to confirm that increasing physical activity also reduces mortality.”
“It is important to emphasize that patients in the STABILITY trial mainly performed low- to moderate-intensity [physical activity], whereas vigorous intensity is known to transiently increase the risk for sudden cardiac death, especially in previously inactive patients,” Thijs M. H. Eijsvogels, PhD, assistant professor in the department of physiology at Radboud University Medical Center in Nijmegen, Netherlands, and Martijn F. H. Maessen, PhD, of the Research Institute for Sports and Exercise Sciences at Liverpool John Moores University in the United Kingdom, wrote in a related editorial. “Therefore, findings from Stewart et al do not exclude the possibility that extreme may worsen cardiovascular outcomes for CHD patients.” – by Darlene Dobkowski
Disclosures: The trial and substudy were funded by GlaxoSmithKline. Stewart reports he received grants and nonfinancial support from GlaxoSmithKline. Eijsvogels and report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
Perspective
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Robert H. Eckel, MD
This analysis simply adds to what is already recommended, but now in patients with established and stable CHD.
This absolutely has an implication for clinical practice. The job of the cardiologist or other health care provider is to first assess stability of CHD and limitations, if any, to exercise and institute an appropriate exercise prescription. Of great interest, those with greatest major CV event risk were those that benefited the most.
Some further research that I would like to see focuses on how do we most successfully change behavior? Why was there major impact on non-CV mortality? Can better tools be developed that are easy to use and interpretable beyond self-reports, and can they be broadly applied?
If you have stable CHD and are sedentary, get moving, and if you’re already quite active, there’s no need to increase physical activity further.
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