Relationship Between Baseline Physical Activity, Self-reported Coronary Heart Disease (CHD) and CHD Risk Factors In Renal Transplant Recipients: Findings From The Folic Acid For Vascular Outcome Reduction In Transplantation (FAVORIT) Trial

Abstract

PURPOSE: To evaluate the relationships between level of physical activity and cardiometabolic health in kidney transplant recipients. METHODS:Baseline data were analyzed in 4,110 stable kidney transplant recipients (1,528 women and 2,582 men) enrolled in the FAVORIT Trial. Physical activity was measured using the Yale Physical Activity Survey (YPAS) summary (SS), walking (WALK) and sitting (SIT) scores. Self-reported CHD and CHD risk factors were assessed. Trends in cardiometabolic health were examined across tertiles of YPAS-SS. RESULTS:Subjects were 51.9 ± 9.4 years old and 77% were White. A kidney transplant was received 5.5 ± 5 years ago, 91% had stage II or III chronic kidney disease, and 20% had prevalent CHD. YPAS-SS was 39.9 (± 20.6), WALK was 11.8 ± 12 and SIT was 2.3 ± 1. Total cholesterol, LDL-C, HDL-C, and triglycerides respectively were 184.5 ± 43.9 mg/dl, 89.5 ± 44.6 mg/dl, 46.2 ± 13.9 mg/dl and 199.8 ± 182.5 mg/dl. Smoking pack-years were 18.0 ± 21.2, systolic blood pressure (BP) was 136 ± 19.7 mmHg, and diastolic BP was 78.5 ± 12.2 mmHg. Distribution of risk factors across tertiles of YPAS-SS were examined; corresponding 2-sided p-values from Kruskal-Wallis rank test are reported. 34% of overweight/obese patients were in the 1st tertile (lower activity) vs. 24% of non-overweight patients (p=0.001); 38% of diabetic patients were in the 1st tertile vs. 27% of non-diabetic patients (p<0.0001); and 41% of patients with prevalent CHD were in the 1st tertile vs 28% of those without prevalent CHD (p=0.0003). Associations with smoking status and hypertension were in the opposite direction (i.e., 28% of current and 29% of former smokers are in the 1st tertile vs. 33% of never smokers (p=0.047); 34% of normotensive patients were in the 1st tertile vs. 27% of hypertensive subjects, p=0.029). CONCLUSIONS:Significant associations between levels of physical activity and several cardiometabolic risk factors and prevalent CHD were not always in the expected direction. These results demonstrate the complexity of relationships between the YPAS-SS and traditional CHD risk factors in persons with CKD.