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Abstract
BackgroundPhysical activity has been associated with a significant reduction in risk of sudden cardiac death in epidemiological studies, however, the strength of the association needs clarification. We conducted a systematic review and meta-analysis to summarize the available data from population-based prospective studies.MethodsPubMed and Embase databases were searched for studies of physical activity and sudden cardiac death from inception to March 26th 2019. Prospective studies reporting adjusted relative risk (RR) estimates and 95% confidence intervals (CIs) of sudden cardiac death associated with physical activity were included. A random effects model was used to estimate summary RRs (95% CIs).ResultsThirteen prospective studies were included in the systematic review. Eight prospective studies with 1193 sudden cardiac deaths among 136,298 participants were included in the meta-analysis of physical activity and sudden cardiac death and the summary RR for highest vs. lowest level of physical activity was 0.52 (95% CI: 0.45–0.60, I2 = 0%, pheterogeneity = 0.72). The association was similar in men and women and among American and European studies. In the dose-response analysis the summary RR was 0.68 (95% CI: 0.55–0.86, I2 = 44%, n = 3) per 20 MET-hours/week. Although the test for nonlinearity was not significant, pnonlinearity = 0.18, there was no further reduction in risk beyond 20–25 MET-hours/week. The summary RR was 0.58 (95% CI: 0.41–0.81, I2 = 0%, pheterogeneity = 0.65, n = 2) for the highest vs. the lowest level of cardiorespiratory fitness.ConclusionThis meta-analysis suggest that a high compared to a low level of physical activity may reduce the risk of sudden cardiac death in the general population. Further studies are needed to clarify the dose-response relationship between specific subtypes and intensities of physical activity in relation to sudden cardiac death.
Highlights
Physical activity has been associated with a significant reduction in risk of sudden cardiac death in epidemiological studies, the strength of the association needs clarification
Given the relatively limited number of established risk factors for sudden cardiac death it is of major public health importance to clarify whether there is an association between physical activity and sudden cardiac death and to define the strength and shape of the dose-response relationship more precisely
The literature search identified 4080 records in total from which 72 were assessed in more detail and ten publications with data from thirteen prospective cohort studies were included in the systematic review and meta-analysis (Fig. 1)
Summary
Physical activity has been associated with a significant reduction in risk of sudden cardiac death in epidemiological studies, the strength of the association needs clarification. Given the relatively limited number of established risk factors for sudden cardiac death it is of major public health importance to clarify whether there is an association between physical activity and sudden cardiac death and to define the strength and shape of the dose-response relationship more precisely. This is important for primary prevention, comparative risk assessment purposes, and identification of knowledge gaps and further areas of research. We conducted a systematic review and meta-analysis of population-based prospective studies on physical activity and cardiorespiratory fitness and the risk of sudden cardiac death
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