Gonzalez-Jaramillo Nathalia, Wilhelm Matthias, Arango-Rivas Ana María, Gonzalez-Jaramillo Valentina, Mesa-Vieira Cristina, Minder Beatrice, Franco Oscar H, Bano Arjola
University of Bern, Institute of Social and Preventive Medicine, Bern, Switzerland; Graduate School for Health Sciences, University of Bern, Bern, Switzerland; Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
J Am Coll Cardiol. 2022 May 3;79(17):1690-1700. doi: 10.1016/j.jacc.2022.02.036.
The role of lifestyle physical activity (PA) trajectories in the mortality risk of patients with coronary heart disease (CHD) remains unclear.
The purpose of this study was to determine the association of longitudinal PA trajectories with all-cause and cardiovascular disease (CVD) mortality in patients with CHD.
Longitudinal cohorts reporting the association of PA trajectories with mortality in patients with CHD were identified in April 2021 by searching 5 databases without language restrictions. Published HRs and 95% CIs were pooled using random effects models and bias assessed by Egger regression.
A total of 9 prospective cohorts included 33,576 patients. The mean age was 62.5 years. The maximum follow-up was 15.7 years. All of the studies assessed PA through validated questionnaires, and mortality was well documented. Changes in PA defined 4 nominal PA trajectories. Compared with always-inactive patients, the risk of all-cause mortality was 50% lower in those who remained active (HR: 0.50; 95% CI: 0.39-0.63); 45% lower in those who were inactive but became active (HR: 0.55; 95% CI: 0.44-0.7); and 20% lower in those who were active but became inactive (HR: 0.80; 95% CI: 0.64-0.99). Similar results were observed for CVD mortality, except for the category of decreased activity (HR: 0.91; 95% CI: 0.67-1.24). The overall risk of bias was low. No evidence of publication bias was found. Multiple sensitivity analyses provided consistent results.
This study illustrates how patients with CHD may benefit by preserving or adopting an active lifestyle. The observation that the benefits of past activity can be weakened or lost if PA is not maintained may be confounded by disease progression.
生活方式体力活动（PA）轨迹在冠心病（CHD）患者死亡风险中的作用尚不清楚。
本研究旨在确定CHD患者纵向PA轨迹与全因死亡率和心血管疾病（CVD）死亡率之间的关联。
2021年4月，通过检索5个无语言限制的数据库，确定了报告PA轨迹与CHD患者死亡率之间关联的纵向队列。使用随机效应模型汇总已发表的风险比（HR）和95%置信区间（CI），并通过Egger回归评估偏倚。
共有9个前瞻性队列，包括33576例患者。平均年龄为62.5岁。最长随访时间为15.7年。所有研究均通过经过验证的问卷评估PA，死亡率记录良好。PA的变化定义了4种名义PA轨迹。与始终不活动的患者相比，保持活动的患者全因死亡风险降低50%（HR：0.50；95%CI：0.39-0.63）；从不活动变为活动的患者降低45%（HR：0.55；95%CI：0.44-0.7）；从活动变为不活动的患者降低20%（HR：0.80；95%CI：0.64-0.99）。CVD死亡率观察到类似结果，但活动减少组除外（HR：0.91；95%CI：0.67-1.24）。总体偏倚风险较低。未发现发表偏倚的证据。多项敏感性分析提供了一致的结果。
本研究说明了CHD患者如何通过保持或采用积极的生活方式而获益。如果不保持PA，过去活动的益处可能会减弱或丧失，这一观察结果可能会因疾病进展而混淆。
