Department of Internal Medicine, Division of Cardiovascular Medicine, Penn State University School of Medicine, Hershey, PA, USA.
Am J Cardiol. 2013 Apr 1;111(7):1034-9. doi: 10.1016/j.amjcard.2012.12.018. Epub 2013 Jan 19.
The clinical expression of hypertrophic cardiomyopathy (HC) is undoubtedly influenced by modifying genetic and environmental factors. Lifestyle practices such as tobacco and alcohol use, poor nutritional intake, and physical inactivity are strongly associated with adverse cardiovascular outcomes and increased mortality in the general population. Before addressing the direct effect of such modifiable factors on the natural history of HC, it is critical to define their prevalence in this population. A voluntary survey, drawing questions in part from the 2007 to 2008 National Health and Nutrition Examination Survey (NHANES), was posted on the HC Association website and administered to patients with HC at the University of Michigan. Propensity score matching to NHANES participants was used. Dichotomous and continuous health behaviors were analyzed using logistic and linear regression, respectively, and adjusted for body mass index and propensity score quintile. Compared to the matched NHANES participants, the patients with HC reported significantly less alcohol and tobacco use but also less time engaged in physical activity at work and for leisure. Time spent participating in vigorous or moderate activity was a strong predictor of self-reported exercise capacity. The body mass index was greater in the HC cohort than in the NHANES cohort. Exercise restrictions negatively affected emotional well-being in most surveyed subjects. In conclusion, patients with HC are less active than the general United States population. The well-established relation of inactivity, obesity, and cardiovascular mortality might be exaggerated in patients with HC. More data are needed on exercise in those with HC to strike a balance between acute risks and the long-term health benefits of exercise.
肥厚型心肌病 (HC) 的临床表现无疑受到遗传和环境因素的影响。生活方式的实践，如吸烟和饮酒、不良的营养摄入和缺乏身体活动，与一般人群的不良心血管结局和死亡率增加密切相关。在探讨这些可改变因素对 HC 自然史的直接影响之前，首先需要明确这些因素在该人群中的流行情况。我们对密歇根大学 HC 患者进行了一项基于问卷调查的研究，调查问卷部分内容来源于 2007 年至 2008 年全国健康和营养调查（NHANES）。该调查结果发布在 HC 协会的网站上，并通过倾向评分匹配（PSM）分析与 NHANES 参与者进行比较。分别采用逻辑回归和线性回归分析二分和连续健康行为，并对体重指数和倾向评分五分位数进行校正。与匹配的 NHANES 参与者相比，HC 患者报告的饮酒和吸烟明显减少，但工作和休闲时的身体活动时间也较少。积极或适度活动的时间长短是自我报告运动能力的一个重要预测因素。与 NHANES 队列相比，HC 队列的体重指数更高。运动限制对大多数接受调查的患者的情绪健康产生负面影响。总之，HC 患者的活动量低于美国一般人群。不活动、肥胖和心血管死亡率之间的既定关系可能在 HC 患者中被夸大。需要更多的数据来了解运动对 HC 患者的影响，以在急性风险和运动的长期健康益处之间取得平衡。
