Abstract
BackgroundAmbiguity exists in relation to the role of physical activity (PA) for cardiovascular disease (CVD) risk reduction. We examined the interplay between PA dimensions and more conventional CVD risk factors to assess which PA dimensions were associated with the first CVD event and whether subgroup differences exist.MethodsA total of 1449 individuals [median age 65.8 (IQR: 61.2, 70.7) years] with low to high risk of type 2 diabetes and free from CVD from the Danish ADDITION-PRO study were included for survival analysis. PA was measured by individually calibrated heart rate and movement sensing for 7 consecutive days. The associations of different PA dimensions (PA energy expenditure, time spent in light-, moderate- and vigorous intensity PA), sedentary time and other conventional CVD risk factors with the first CVD event were examined by tree-structured survival analysis. Baseline information was linked to data on the first CVD event (ischemic heart disease, ischemic stroke, heart failure, atrial flutter/fibrillation and atherosclerotic disease) and mortality obtained from Danish registers.ResultsDuring a median follow-up time of 5.5 (IQR: 5.1–6.1) years, a total of 201 individuals (13.9%) developed CVD. Overall CVD incidence rate was 2.6/100 person-years. PA energy expenditure above 43 kJ/kg/day was associated with lower rates of CVD events among participants ≤ 70 years and with HbA1c ≤ 5.7% (39 mmol/mol), systolic blood pressure ≤ 156 mmHg and albumin creatinine ratio ≤ 70 (incidence rates 0.0–0.8/100 person-years).ConclusionsAny type of PA resulting in increased PA energy expenditure may over time be the best prevention strategy to uphold reduced risk of CVD.
Highlights
As in the general population, cardiovascular disease (CVD) is a major contributor to morbidity and mortality in individuals with pre-diabetes and type 2 diabetes
The sampling frame for the ADDITIONPRO study consisted of participants classified in groups of increasing type 2 diabetes risk according to the type 2 diabetes risk score and glycaemic status: low type 2 diabetes risk (< 5 points on type 2 diabetes risk score); high type 2 diabetes risk (≥ 5 points on type 2 diabetes risk score) with (i) normoglycemia; (ii) isolated impaired fasting glucose; (ii) isolated impaired glucose tolerance; and (iv) combined impaired fasting glucose and impaired glucose tolerance
Findings showed that individuals with low HbA1c and a good general health experienced the most significant reduction in CVD events from the intervention [33]. These findings support the notion that the impact of physical activity (PA) in subgroups with unfavourable CVD profiles is attenuated and may emphasize the importance of being physically active when CVD risk is still low. Another reason why we found no PA dimension associated with CVD in the subgroups with unfavorable CVD profiles, could be that individuals in these subgroups show homogeneous PA patterns
Summary
As in the general population, cardiovascular disease (CVD) is a major contributor to morbidity and mortality in individuals with pre-diabetes and type 2 diabetes. In these high-risk individuals the risk of developing CVD is greatly increased [1, 2]. Observational studies have demonstrated that greater amounts of PA are associated with lower rates of incident and recurrent CVD [5, 6] This is not unambiguously supported by results from large randomized controlled trials of lifestyle interventions in subgroups at high CVD risk [7]. We examined the interplay between PA dimensions and more conventional CVD risk factors to assess which PA dimensions were associated with the first CVD event and whether subgroup differences exist
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