Division of Cardiology, Department of Internal Medicine, Dongtan Sacred Heart Hospital, Hwaseong, Korea.
Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea.
BMC Public Health. 2024 May 6;24(1):1241. doi: 10.1186/s12889-024-18724-2.
The impact of changes in physical activity after ischemic stroke (IS) on the subsequent myocardial infarction (MI) risk is not fully understood. We aimed to investigate the effects of changes in physical activity on the risk of MI after acute IS using data from the Korean National Health Insurance Services Database.
224,764 patients newly diagnosed with IS between 2010 and 2016 who underwent two serial biannual health checkups were included. The participants were divided into four categories according to changes in their physical activity: persistent non-exercisers, new exercisers, exercise dropouts, and exercise maintainers. The primary outcome was a new diagnosis of incident MI. Multivariable Cox proportional models were used to assess the effects of changes in exercise habits on the risk of MI.
After a median of 4.25 years of follow-up, 6,611 (2.94%) MI cases were observed. After adjusting for confounders, new exercisers and exercise maintainers were significantly associated with a lower risk of incident MI than persistent non-exercisers (aHR, 0.849; 95% CI, 0.792-0.911; P-value < 0.001; and aHR, 0.746; 95% CI, 0.696-0.801; P-value < 0.001, respectively). Effects were consistent across sexes, more pronounced in those > 65 years. Notably, any level of physical activity after stroke was associated with a reduced MI risk compared to no exercise.
In this nationwide cohort study, commencing or sustaining physical activity after an IS corresponded to a diminished likelihood of subsequent MI development. Advocating physical activity in ambulatory stroke survivors could potentially attenuate the prospective risk of MI.
缺血性卒中（IS）后体力活动变化对随后心肌梗死（MI）风险的影响尚不完全清楚。我们旨在使用韩国国家健康保险服务数据库的数据来研究体力活动变化对急性 IS 后 MI 风险的影响。
2010 年至 2016 年期间，共纳入 224764 例新诊断为 IS 的患者，这些患者均接受了两次半年一次的健康检查。根据体力活动的变化，将参与者分为四组：持续不运动者、新运动者、运动减少者和运动保持者。主要结局为新发 MI 的诊断。多变量 Cox 比例模型用于评估运动习惯变化对 MI 风险的影响。
在中位数为 4.25 年的随访期间，观察到 6611 例（2.94%）MI 病例。在调整混杂因素后，与持续不运动者相比，新运动者和运动保持者发生新发 MI 的风险显著降低（aHR，0.849；95%CI，0.792-0.911；P 值<0.001；和 aHR，0.746；95%CI，0.696-0.801；P 值<0.001）。这些效果在性别之间是一致的，在年龄>65 岁的人群中更为明显。值得注意的是，与无运动相比，卒中后任何水平的体力活动均与 MI 风险降低相关。
在这项全国性队列研究中，IS 后开始或保持体力活动与随后 MI 发展的可能性降低相关。在活动能力的卒中幸存者中提倡体力活动可能会降低 MI 的预期风险。
