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Exercise can decrease genetic risk for CVD
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Physical activity and fitness were inversely associated with incident CVD among patients from the general population and those with an elevated genetic risk for CVD, according to a study published in Circulation.
“The main message of this study is that being physically active is associated with a lower risk of heart disease, even if you have a high genetic risk,” Erik Ingelsson, MD, PhD, professor of cardiovascular medicine at Stanford University School of Medicine, said in a press release.
Emmi Tikkanen, PhD, a postdoctoral research fellow at Stanford University at the time of the study and now a senior data scientist at Nightingale Health in Helsinki, and colleagues analyzed data from 502,635 participants (mean age, 57 years; 54% women) from the UK Biobank cohort without prevalent CVD events. Available data included assessments on health-related factors, physical measurements and urine, blood and saliva samples.
The exposures of interest were different measures of physical activity and fitness, including total physical activity, grip strength and cardiorespiratory fitness. The International Physical Activity Questionnaire was used to assess frequency and duration of moderate-intensity exercise, walking and vigorous exercise.
Disease outcomes of interest were primary or secondary events such as CHD, stroke, HF, atrial fibrillation and CABG. Participants were followed for a median of 6.1 years.
The incidence of CHD was associated with grip strength (HR = 0.79; 95% CI, 0.77-0.81), International Physical Activity Questionnaire (HR = 0.95; 95% CI, 0.93-0.97) and cardiorespiratory fitness (HR = 0.68; 95% CI, 0.63-0.74). This was also seen in AF for International Physical Activity Questionnaire (HR = 0.93; 95% CI, 0.91-0.95), grip strength (HR = 0.75; 95% CI, 0.73-0.76) and cardiorespiratory fitness (HR = 0.6; 95% CI, 0.56-0.65).
Cardiorespiratory fitness and grip strength were inversely associated with incident AF and CHD in each genetic risk score group (P for trend < .001 for each group). Compared with participants with low cardiorespiratory fitness, those with high cardiorespiratory fitness decreased the risk for AF by 60% (HR = 0.4; 95% CI, 0.3-0.55) and CHD by 49% (HR = 0.51; 95% CI, 0.38-0.69) in participants at the highest tertiles of AF and CHD genetic risk scores.
“Although more information is needed to evaluate how people understand the genetic risks, the knowledge that lifestyle choices have substantial effects on the disease risks could encourage individuals to initiate a healthier lifestyle to reduce their overall risk,” Tikkanen and colleagues wrote. – by Darlene Dobkowski
Disclosures: Ingelsson reports he is a scientific adviser for Precision Wellness and Olink Proteomics. Tikkanen and the other authors report no relevant financial disclosures.
Perspective
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Amit V. Khera, MD
These results make use of the UK Biobank study, a study that enrolled more than 500,000 patients between 2006 and 2010 to understand the genetic and environmental drivers of disease. The enrollment included questionnaire data about exercise activity, directly assessed measure of fitness (grip strength, exercise testing) and linkage to electronic health records.
Importantly, this UK Biobank resource has been made available to the world and has already led to important analyses. This reflects a new model of big data and data sharing to accelerate research.
Here, researchers demonstrate that individuals with more regular exercise or enhanced fitness had significantly lower rates of mortality and CV outcomes. This can directly inform public health efforts to enhance the fitness within our society.
The researchers also note that the protective effect of exercise was noted even amongst those who were genetically susceptible to MI or AF — this again reaffirms the concept that our DNA can increase our risk substantially but is not deterministic. Healthy lifestyle can powerfully modify risk regardless of one’s genetic profile.
These results confirm and extend our recent analysis that looked at the interplay of genetics and lifestyle as they relate to risk for coronary events (Khera AV, et al. N Engl J Med. 2016;doi:10.1056/NEJMoa1605086).
Moving forward, it will be important to understand how to use such results to motivate favorable lifestyle changes, especially among those who are at the highest genetic risk and thus have the most to gain.
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