Apullan Francisco Javier, Bourassa Martial G, Tardif Jean-Claude, Fortier Annik, Gayda Mathieu, Nigam Anil
Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada.
Am J Cardiol. 2008 Aug 15;102(4):375-9. doi: 10.1016/j.amjcard.2008.03.072. Epub 2008 May 22.
Self-reported leisure-time physical activity level correlates well with both cardiovascular (CV) and non-CV mortality in subjects without coronary heart disease (CHD). The impact of leisure-time physical activity on long-term outcomes has not been well studied in patients with preexisting CHD, who are often physically limited because of symptoms, medications, and co-morbid conditions. The aim was to determine the long-term prognostic value of self-reported leisure-time physical activity in a large CHD cohort. Leisure-time physical activity was evaluated using a self-administered questionnaire and categorized using a 4-level scale (sedentary, mild, moderate, and strenuous) in 14,021 of 24,958 subjects from the Coronary Artery Surgery Study Registry with suspected or proven CHD who underwent cardiac catheterization from 1974 to 1979. Median long-term follow-up was 14.7 years (interquartile range 9.8 to 16.2). Clinical outcomes were evaluated according to physical activity level and adjusted for potential confounders. Long-term all-cause and CV mortality progressively increased from most to least active subjects, with sedentary patients showing a 1.6-fold increase in mortality for both these outcomes (hazard ratio [HR] 1.63, 95% confidence interval [CI] 1.34 to 1.97, p <0.0001 for all-cause mortality). Similar trends were noted for men and women and in adjusted models, although HRs were attenuated after adjusting for age, gender, smoking, hypertension, diabetes mellitus, total cholesterol, body mass index, and ejection fraction (adjusted HR 1.23, 95% CI 1.01 to 1.49, p = 0.03 for all-cause mortality; adjusted HR 1.25, 95% CI 0.99 to 1.57, p = 0.05 for CV mortality). In conclusion, leisure-time physical activity independently predicted long-term survival in men and women with chronic stable CHD.
在无冠心病（CHD）的受试者中，自我报告的休闲时间身体活动水平与心血管（CV）和非CV死亡率均密切相关。对于已有CHD的患者，休闲时间身体活动对长期预后的影响尚未得到充分研究，这些患者常因症状、药物和合并症而身体受限。本研究旨在确定自我报告的休闲时间身体活动在一个大型CHD队列中的长期预后价值。在1974年至1979年接受心脏导管插入术的24958名疑似或确诊CHD的冠状动脉手术研究注册受试者中，有14021名使用自我管理问卷对休闲时间身体活动进行了评估，并采用4级量表（久坐、轻度、中度和剧烈）进行分类。中位长期随访时间为14.7年（四分位间距9.8至16.2年）。根据身体活动水平评估临床结局，并对潜在混杂因素进行校正。长期全因死亡率和CV死亡率从最活跃的受试者到最不活跃的受试者逐渐增加，久坐的患者这两种结局的死亡率均增加了1.6倍（风险比[HR]1.63，95%置信区间[CI]1.34至1.97，全因死亡率p<0.0001）。男性和女性以及校正模型中均观察到类似趋势，尽管在校正年龄、性别、吸烟、高血压、糖尿病、总胆固醇、体重指数和射血分数后HR有所减弱（全因死亡率校正HR 1.23，95%CI 1.01至1.49，p = 0.03；CV死亡率校正HR 1.25，95%CI 0.99至1.57，p = 0.05）。总之，休闲时间身体活动可独立预测慢性稳定CHD男性和女性的长期生存。
