体力活动与绝经后女性心力衰竭发生率。
Physical Activity and Incidence of Heart Failure in Postmenopausal Women.
机构信息
Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York.
Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
出版信息
JACC Heart Fail. 2018 Dec;6(12):983-995. doi: 10.1016/j.jchf.2018.06.020. Epub 2018 Sep 5.
OBJECTIVES
This study prospectively examined physical activity levels and the incidence of heart failure (HF) in 137,303 women, ages 50 to 79 years, and examined a subset of 35,272 women who, it was determined, had HF with preserved ejection fraction (HFpEF) and HF with reduced EF (HFrEF).
BACKGROUND
The role of physical activity in HF risk among older women is unclear, particularly for incidence of HFpEF or HFrEF.
METHODS
Women were free of HF and reported ability to walk at least 1 block without assistance at baseline. Recreational physical activity was self-reported. The study documented 2,523 cases of total HF, and 451 and 734 cases of HFrEF and HFpEF, respectively, during a mean 14-year follow-up.
RESULTS
After controlling for age, race, education, income, smoking, alcohol, hormone therapy, and hysterectomy status, compared with women who reported no physical activity (reference group), inverse associations were observed across incremental tertiles of total physical activity for overall HF (hazard ratio [HR]: Tertile 1 = 0.89, Tertile 2 = 0.74, Tertile 3 = 0.65; trend p < 0.001), HFpEF (HR: 0.93, 0.70, 0.68; p < 0.001), and HFrEF (HR: 0.81, 0.59, 0.68; p = 0.01). Additional controlling for potential mediating factors included attenuated time-varying coronary heart disease (CHD) (nonfatal myocardial infarction, coronary revascularization) diagnosis but did not eliminate the inverse associations. Walking, the most common form of physical activity in older women, was also inversely associated with HF risks (overall: 1.00, 0.98, 0.93, 0.72; p < 0.001; HFpEF: 1.00, 0.98, 0.87, 0.67; p < 0.001; HFrEF: 1.00, 0.75, 0.78, 0.67; p = 0.01). Associations between total physical activity and HF were consistent across subgroups, defined by age, body mass index, diabetes, hypertension, physical function, and CHD diagnosis. Analysis of physical activity as a time-varying exposure yielded findings comparable to those of baseline physical activity.
CONCLUSIONS
Higher levels of recreational physical activity, including walking, are associated with significantly reduced HF risk in community-dwelling older women.
目的
本研究前瞻性地检查了 137303 名年龄在 50 至 79 岁之间的女性的身体活动水平和心力衰竭（HF）的发病率，并检查了其中 35272 名女性的亚组，这些女性被确定患有射血分数保留的心力衰竭（HFpEF）和射血分数降低的心力衰竭（HFrEF）。
背景
身体活动在老年女性 HF 风险中的作用尚不清楚，特别是对于 HFpEF 或 HFrEF 的发病率。
方法
女性在基线时无 HF 且报告能够在没有帮助的情况下至少行走 1 个街区。休闲体育活动是自我报告的。在平均 14 年的随访期间，该研究记录了 2523 例总 HF，451 例和 734 例 HFrEF 和 HFpEF。
结果
在控制年龄、种族、教育、收入、吸烟、饮酒、激素治疗和子宫切除术状态后，与报告无身体活动的女性（参考组）相比，整体 HF（危险比[HR]：第 1 tertile = 0.89，第 2 tertile = 0.74，第 3 tertile = 0.65；趋势 p < 0.001）、HFpEF（HR：0.93、0.70、0.68；p < 0.001）和 HFrEF（HR：0.81、0.59、0.68；p = 0.01）的总身体活动的各个递增 tertile 均呈反比关系。进一步控制潜在的中介因素，包括减弱了时间变化的冠心病（CHD）（非致命性心肌梗死，冠状动脉血运重建）诊断，但并未消除反比关系。步行是老年女性最常见的体育活动形式，也与 HF 风险呈反比（整体：1.00、0.98、0.93、0.72；p < 0.001；HFpEF：1.00、0.98、0.87、0.67；p < 0.001；HFrEF：1.00、0.75、0.78、0.67；p = 0.01）。总身体活动与 HF 之间的关联在年龄、体重指数、糖尿病、高血压、身体功能和 CHD 诊断定义的亚组中是一致的。将身体活动作为时间变化的暴露进行分析，得出的结果与基线身体活动的结果相当。
结论
在社区居住的老年女性中，休闲体育活动水平较高，包括步行，与 HF 风险显著降低相关。
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