Data question universal restriction of vigorous exercise for people with HCM
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NEW ORLEANS — Adults with hypertrophic cardiomyopathy who engaged in vigorous exercise were at no greater risk for death, cardiac arrest or other outcomes compared with those engaging in low-to-moderate-intensity physical activity.
In a prospective study of more than 1,600 people with hypertrophic cardiomyopathy (HCM), which also included those with genotype-positive/phenotype-negative HCM, researchers found that people participating in high-intensity competitive sports were also not at heightened risk, Rachel Lampert, MD, FACC, the Robert W. Berliner Professor of Medicine (Cardiology) at Yale School of Medicine, said during a late-breaking clinical trial presentation at the American College of Cardiology Scientific Session.
“In neither the primary patient population nor any subgroup comparison was either vigorous or non-vigorous exercise shown to be safer,” Lampert said during the presentation.
The concern for risk for ventricular arrhythmia and sudden death has led to restriction of vigorous exercise for individuals with HCM; however, prospective comparative data are lacking on the safety of vigorous exercise for people with HCM, Lampert said.
“Thus, our objective was to determine if engagement in vigorous exercise, including competitive sports, is associated with increased risk for life-threatening ventricular arrhythmia and/or mortality in individuals with HCM followed prospectively over 3 years,” Lampert said.
Lampert and colleagues analyzed data from people with a diagnosis of HCM or those who had a pathologic genetic variant without left ventricular hypertrophy (phenotype-negative) from 42 sites in the U.S., U.K., Canada, Australia and New Zealand, recruited between May 2015 and February 2019. Participants completed the Minnesota Leisure Time Activity Questionnaire at baseline, which classified activity as vigorous (at least one activity with metabolic equivalents of task [METS] > 6 for 60 hours per year), moderate (all activities 4 and < 6 METS for 60 hours per year) or sedentary. Researchers obtained records from participants’ primary cardiologists and surveyed participants every 6 months for occurrence of events (death, resuscitated cardiac arrest, syncope or appropriate shock from an implantable cardioverter defibrillator review by two electrophysiologists).
The primary analysis was time-to-event for participants who participated in vigorous vs. non-vigorous activity, controlling for age, sex, race, recruitment (self-enrolled vs. site), age at diagnosis and presence of an ICD.
Within the cohort, 961 participants participated in non-vigorous exercise or were sedentary (mean age, 40.5 years; 53.9% men) and 699 participated in vigorous exercise (mean age, 36.1 years; 66.8% men); 259 participants self-identified as competitive athletes at a league, varsity or professional level (mean age, 29.3 years; 65.3% men), Lampert said.
For the composite endpoint, the event rate was 15.3 per 1,000 person-years in the non-vigorous group (90% CI, 11.4-20.5) and 15.9 per 1,000 person-years in the vigorous exercise group (90% CI, 11.3-22.4), for an HR of 1.01 (90% CI, 0.68-1.48; P = .98).
“Events were similar between the groups for the individual endpoints of death, [cardiac] arrest, syncope or appropriate shock, although the individual events were not frequent enough for meaningful comparison,” Lampert said.
Post hoc analyses controlling for markers that differed between groups, such as history of arrest — as well as analyses restricted to participants with overt HCM only and analyses restricted to only those who were phenotype-negative — did not impact the findings, Lampert said.
Lampert noted that participants self-selected for this study and that most were cared for at high-volume HCM centers; whether the findings translate to people receiving care outside of such centers is unknown.
“Overall event rates were low, with less than 5% experiencing the composite endpoint over 3 years,” Lampert said. “These data do not support universal restriction of vigorous exercise in patients with hypertrophic cardiomyopathy. Rather, these data should inform discussions between patients and physicians regarding vigorous exercise participation, in the context of expert assessment and management of HCM, using an individualized shared decision-making framework.”
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Lampert R, et al. Late-Breaking Clinical Trials V. Presented at: American College of Cardiology Scientific Session; March 4-6, 2023; New Orleans (hybrid meeting).
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