Faselis Charles, Kokkinos Peter, Tsimploulis Apostolos, Pittaras Andreas, Myers Jonathan, Lavie Carl J, Kyritsi Fiorina, Lovic Dragan, Karasik Pamela, Moore Hans
Cardiology Division, Veterans Affairs Medical Center, Washington, DC; George Washington University School of Medicine, Washington, DC.
Cardiology Division, Veterans Affairs Medical Center, Washington, DC; Georgetown University School of Medicine, Washington, DC; Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia.
Mayo Clin Proc. 2016 May;91(5):558-66. doi: 10.1016/j.mayocp.2016.03.002. Epub 2016 Apr 8.
To assess the association between exercise capacity and the risk of developing atrial fibrillation (AF).
A symptom-limited exercise tolerance test was conducted to assess exercise capacity in 5962 veterans (mean age, 56.8±11.0 years) from the Veterans Affairs Medical Center, Washington, DC. None had evidence of AF or ischemia at the time of or before undergoing their exercise tolerance test. We established 4 fitness categories based on age-stratified quartiles of peak metabolic equivalent task (MET) achieved: least fit (4.9±1.10 METs; n=1446); moderately fit (6.7±1.0 METs; n=1490); fit (7.9±1.0 METs; n=1585), and highly fit (9.3±1.2 METs; n=1441). Multivariable Cox proportional hazards regression models were used to compare the AF-exercise capacity association between fitness categories.
During a median follow-up period of 8.3 years, 722 (12.1%) individuals developed AF (14.5 per 1000 person-years; 95% CI, 13.9-15.9 per 1000 person-years). Exercise capacity was inversely related to AF incidence. The risk was 21% lower (hazard ratio, 0.79; 95% CI, 0.76-0.82) for each 1-MET increase in exercise capacity. Compared with the least fit individuals, hazard ratios were 0.80 (95% CI, 0.67-0.97) for moderately fit individuals, 0.55 (95% CI, 0.45-0.68) for fit individuals, and 0.37 (95% CI, 0.29-0.47) for highly fit individuals. Similar trends were observed in those younger than 65 years and those 65 years or older.
Increased fitness is inversely and independently associated with the reduced risk of developing AF. The decrease in risk was graded and precipitous with only modest increases in exercise capacity. These findings counter previous suggestions that even moderate increases in physical activity, as recommended by national and international guidelines, increase the risk of AF, with marked protection against AF noted with increasing levels of fitness.
评估运动能力与发生心房颤动（AF）风险之间的关联。
对来自华盛顿特区退伍军人事务医疗中心的5962名退伍军人（平均年龄56.8±11.0岁）进行了症状限制性运动耐量测试，以评估其运动能力。在进行运动耐量测试时或测试前，这些人都没有AF或缺血的证据。我们根据达到的峰值代谢当量任务（MET）按年龄分层的四分位数建立了4个健康类别：健康程度最低（4.9±1.10 METs；n = 1446）；中等健康（6.7±1.0 METs；n = 1490）；健康（7.9±1.0 METs；n = 1585），以及非常健康（9.3±1.2 METs；n = 1441）。使用多变量Cox比例风险回归模型来比较不同健康类别之间的AF与运动能力的关联。
在中位随访期8.3年期间，722名（12.1%）个体发生了AF（每1000人年14.5例；95%CI，每1000人年13.9 - 15.9例）。运动能力与AF发病率呈负相关。运动能力每增加1 MET，风险降低21%（风险比，0.79；95%CI，0.76 - 0.82）。与健康程度最低的个体相比，中等健康个体的风险比为0.80（95%CI，0.67 - 0.97），健康个体为0.55（95%CI，0.45 - 0.68），非常健康个体为0.37（95%CI，0.29 - 0.47）。在65岁以下和65岁及以上的人群中也观察到了类似趋势。
健康程度的提高与发生AF风险的降低呈负相关且独立相关。风险的降低是分级且急剧的，运动能力仅适度增加即可。这些发现与之前的观点相反，即按照国家和国际指南建议，即使适度增加体力活动也会增加AF风险，而随着健康程度的提高对AF有显著的保护作用。
