Zaghi Amir, Holm Hannes, Korduner Johan, Dieden Anna, Molvin John, Bachus Erasmus, Jujic Amra, Magnusson Martin
Department of Clinical Sciences, Lund University, Malmö, Sweden.
Department of Cardiology, Skane University Hospital, Lund University, Malmö, Sweden.
Front Cardiovasc Med. 2022 Feb 21;9:843029. doi: 10.3389/fcvm.2022.843029. eCollection 2022.
Several studies have examined the role of physical activity as a predictor of heart failure (HF) mortality and morbidity. Here, we aimed to evaluate the role of self-reported physical activity as an independent risk factor of post-discharge mortality and re-hospitalization in patients hospitalized for HF, as well as study the association between physical activity and 92 plasma proteins associated with cardiovascular disease (CVD).
Four-hundred-and-thirty-four patients hospitalized for HF (mean age 75 years; 32% women) were screened for physical activity derived from questionnaires in the Swedish national public health survey. The median follow-up time to death and re-hospitalization was 835 (interquartile range, 390-1,432) and 157 (43-583) days, respectively. Associations between baseline reported physical activity, mortality and re-hospitalization risk were analyzed using multivariable Cox regression analysis. Plasma samples from 295 study participants were analyzed with a proximity extension assay consisting of 92 proteins. Associations between proteins and physical activity were explored using a false discovery rate of <5%, and significant associations were taken forward to multivariate analyses.
In the multivariate Cox regression model, physical inactivity, defined as physical activity time <1 h throughout the week was associated with increased risk of all-cause mortality (HR 1.71; CI95% 1.26-2.31; = 5.9 × 10) as well as all-cause re-hospitalization (HR 1.27; CI95% 1.01-1.60; = 0.038). Further, physical inactivity was associated with elevated plasma levels of Metalloproteinase inhibitor 4, Soluble interleukin 1 receptor-like 1, Elafin and Transferrin receptor protein 1, which are implicated in myocardial fibrosis, migration and apoptosis.
Self-reported low weekly physical activity is associated with increased risk of mortality and re-hospitalization in patients hospitalized for HF independent of traditional risk factors. Furthermore, physical inactivity was associated with elevated levels of 4 proteins linked to cardiovascular disease.
多项研究探讨了体力活动作为心力衰竭（HF）死亡率和发病率预测指标的作用。在此，我们旨在评估自我报告的体力活动作为因HF住院患者出院后死亡率和再次住院的独立危险因素的作用，并研究体力活动与92种与心血管疾病（CVD）相关的血浆蛋白之间的关联。
对434例因HF住院的患者（平均年龄75岁；32%为女性）进行筛查，这些患者的体力活动数据来自瑞典国家公共卫生调查中的问卷。至死亡和再次住院的中位随访时间分别为835天（四分位间距，390 - 1432天）和157天（43 - 583天）。使用多变量Cox回归分析来分析基线报告的体力活动、死亡率和再次住院风险之间的关联。对295名研究参与者的血浆样本进行了包含92种蛋白质的邻位延伸分析。使用错误发现率<5%来探索蛋白质与体力活动之间的关联，并将显著关联纳入多变量分析。
在多变量Cox回归模型中，被定义为每周体力活动时间<1小时的缺乏体力活动与全因死亡率风险增加相关（风险比1.71；95%置信区间1.26 - 2.31；P = 5.9×10⁻³）以及全因再次住院风险增加相关（风险比1.27；95%置信区间1.01 - 1.60；P = 0.038）。此外，缺乏体力活动与金属蛋白酶抑制剂4、可溶性白细胞介素1受体样分子1、弹性蛋白和转铁蛋白受体蛋白1的血浆水平升高相关，这些蛋白与心肌纤维化、迁移和凋亡有关。
自我报告的每周低体力活动与因HF住院患者的死亡率和再次住院风险增加有关独立于传统危险因素。此外，缺乏体力活动与4种与心血管疾病相关的蛋白质水平升高有关。
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