Li Teng, Zhang Xingyi, Wang Xiuling, Song Jiali, Tian Aoxi, Wu Chaoqun, Zhang Xiaoyan, Yang Yang, Cui Jianlan, Xu Wei, Song Lijuan, Yang Hao, He Wenyan, Zhang Yan, Li Xi, Zheng Xin
National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 100037 Beijing, China.
Central China Sub-center of the National Center for Cardiovascular Diseases, 450000 Zhengzhou, Henan, China.
Rev Cardiovasc Med. 2023 Feb 22;24(3):67. doi: 10.31083/j.rcm2403067. eCollection 2023 Mar.
Physical activity (PA) is an important component of secondary prevention after myocardial infarction (MI). The mortality risk of MI survivors varies at different post-MI periods, yet the time-varying effect of total PA is unclear. We aimed to investigate the association between different volumes and patterns of total PA and mortality at different post-MI periods.
Using data from the China Patient-centered Evaluative Assessment of Cardiac Events Million Persons Project, we divided the screened MI survivors into within-1-year and beyond-1-year groups based on the duration between their baseline interview and MI onset. Total PA was divided into insufficient ( 3000 metabolic equivalent of task [MET] minutes/week) and sufficient PA. Sufficient PA was further categorized as moderate and high (3000-4500 and 4500 MET minutes/week) volumes; leisure ( 50%) and non-leisure ( 50%) patterns. Data on mortality were derived from the National Mortality Surveillance System and Vital Registration of the Chinese Center for Disease Control and Prevention. Cox proportional hazard models were fitted to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Restricted cubic spline regression analyses were performed to examine the dose-response association between PA and mortality.
During the follow-up (median 3.7 years) of the 20,653 post-MI patients, 751 patients died. In the within-1-year group, moderate (HR: 0.59, 95% CI: 0.40 to 0.88) and high (0.63, 0.45 to 0.88) volumes and both patterns (leisure: 0.52, 0.29 to 0.94; non-leisure: 0.64, 0.46 to 0.88) of PA were all associated with significantly lower risk of mortality, compared with insufficient PA. In the beyond-1-year group, the association was observed in high volume (0.69, 0.56 to 0.86) and both patterns (leisure: 0.64, 0.48 to 0.87; non-leisure: 0.79, 0.65 to 0.97). A non-linear relationship between PA and mortality was found in the within-1-year group ( for non-linearity 0.001), while a linear relationship was demonstrated in the beyond-1-year group ( for non-linearity = 0.107).
Sufficient total PA was associated with mortality risk reduction after MI, either leisure or non-leisure pattern. Different dose-response associations between PA and mortality were found at different post-MI periods. These results could promote individualized and scientifically derived secondary prevention strategies for MI.
身体活动（PA）是心肌梗死（MI）后二级预防的重要组成部分。MI幸存者的死亡风险在MI后的不同时期有所不同，但总PA的时变效应尚不清楚。我们旨在研究不同运动量和总PA模式与MI后不同时期死亡率之间的关联。
利用中国心脏事件万人项目以患者为中心的评估数据，我们根据基线访谈与MI发病之间的持续时间，将筛选出的MI幸存者分为1年内组和1年后组。总PA分为不足（每周<3000代谢当量任务[MET]分钟）和充足PA。充足PA进一步分为中等和高（3000 - 4500和>4500 MET分钟/周）运动量；休闲（>50%）和非休闲（>50%）模式。死亡率数据来自中国疾病预防控制中心的国家死亡监测系统和人口动态登记。采用Cox比例风险模型来估计风险比（HRs）和95%置信区间（CIs）。进行限制立方样条回归分析以检验PA与死亡率之间的剂量反应关联。
在20653例MI后患者的随访（中位时间3.7年）期间，751例患者死亡。在1年内组中，与不足PA相比，中等（HR：0.59，95%CI：0.40至0.88）和高（0.63，0.45至0.88）运动量以及两种模式（休闲：0.52，0.29至0.94；非休闲：0.64，0.46至0.88）的PA均与显著较低的死亡风险相关。在1年后组中，高运动量（0.69，0.56至0.86）以及两种模式（休闲：0.64，0.48至0.87；非休闲：0.79，0.65至0.97）观察到这种关联。在1年内组中发现PA与死亡率之间存在非线性关系（非线性检验P<0.001），而在1年后组中呈现线性关系（非线性检验P = 0.107）。
充足的总PA与MI后死亡风险降低相关，无论是休闲还是非休闲模式。在MI后的不同时期发现PA与死亡率之间存在不同的剂量反应关联。这些结果可促进针对MI的个性化且基于科学的二级预防策略。
