Batty G David, Shipley Martin J, Marmot Michael, Davey Smith George
Epidemiology Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT.
J Public Health Med. 2003 Sep;25(3):190-6. doi: 10.1093/pubmed/fdg043.
Although numerous studies have shown an association between physical activity and coronary heart disease (CHD) mortality in healthy persons, few have reported on this relation in individuals with pre-existing diseases, such as ischaemia. Further, we are unaware of any study to examine if this relationship is modified by the symptomatic nature of the ischaemia.
To explore these issues, we analysed data from a 25 year follow-up of mortality for 6474 male British civil servants who underwent a resting electrocardiogram and responded to queries regarding angina at study entry.
Among men who had ECG abnormalities but no angina (i.e. asymptomatic), activity was associated with a higher rate of CHD mortality. Among men with both angina and ECG abnormalities (i.e. symptomatic), activity was associated with lower CHD mortality but this was not statistically significant at conventional levels.
In the present study, there was a suggestion that the symptomatic nature of ischaemia appeared to modify the effect of physical activity on total and CHD mortality. Although these findings should be examined in other studies, they point to the need for a pre-participation medical examination in active persons or those contemplating embarking on an activity programme.
尽管大量研究表明健康人群的体力活动与冠心病（CHD）死亡率之间存在关联，但很少有研究报道患有缺血等既往疾病的个体中的这种关系。此外，我们不知道是否有任何研究来检验这种关系是否会因缺血的症状性质而改变。
为了探讨这些问题，我们分析了6474名接受静息心电图检查并在研究开始时回答有关心绞痛问题的英国男性公务员25年死亡率随访的数据。
在心电图异常但无心绞痛（即无症状）的男性中，体力活动与较高的冠心病死亡率相关。在既有心绞痛又有心电图异常（即有症状）的男性中，体力活动与较低的冠心病死亡率相关，但在传统水平上这一差异无统计学意义。
在本研究中，有迹象表明缺血的症状性质似乎改变了体力活动对总死亡率和冠心病死亡率的影响。尽管这些发现应在其他研究中进行检验，但它们表明有必要对积极运动的人或考虑开始运动计划的人进行运动前医学检查。
