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Analysis of the dose-response relationship of leisure-time physical activity to cardiovascular disease and all-cause mortality: the REGICOR study.

Authors
  • Clará, Albert1
  • Berenguer, Georgina2
  • Pérez-Fernández, Silvia3
  • Schröder, Helmut4
  • Ramos, Rafel5
  • Grau, María4
  • Dégano, Irene R6
  • Fernández-Sanlés, Alba7
  • Marrugat, Jaume3
  • Elosua, Roberto8
  • 1 Servicio de Angiología y Cirugía Vascular, Hospital del Mar, Barcelona, Spain; Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain; CIBER Enfermedades Cardiovasculares, Barcelona, Spain; Facultad de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain. , (Spain)
  • 2 Facultad de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain. , (Spain)
  • 3 Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain; CIBER Enfermedades Cardiovasculares, Barcelona, Spain. , (Spain)
  • 4 Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain; CIBER Epidemiología y Salud Pública, Barcelona, Spain. , (Spain)
  • 5 Instituto Universitario de Investigación en Atención Primaria Jordi Gol (IDIAP Jordi Gol), Unidad de Apoyo a la Investigación de Girona, Girona, Spain; Instituto de Investigación Biomédica de Girona (IdIBGi), Girona, Spain; Departamento de Ciencias Médicas, Facultad de Medicina, Universidad de Girona, Girona, Spain. , (Spain)
  • 6 Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain; CIBER Enfermedades Cardiovasculares, Barcelona, Spain; Departamento de Medicina, Facultad de Medicina, Universidad de Vic-Central de Cataluña, Vic, Barcelona, Spain. , (Spain)
  • 7 Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain. , (Spain)
  • 8 Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain; CIBER Enfermedades Cardiovasculares, Barcelona, Spain; Departamento de Medicina, Facultad de Medicina, Universidad de Vic-Central de Cataluña, Vic, Barcelona, Spain. Electronic address: [email protected] , (Spain)
Type
Published Article
Journal
Revista espanola de cardiologia (English ed.)
Publication Date
May 01, 2021
Volume
74
Issue
5
Pages
414–420
Identifiers
DOI: 10.1016/j.rec.2020.02.011
PMID: 32446794
Source
Medline
Keywords
Language
Spanish
License
Unknown

Abstract

Regular leisure-time physical activity (LTPA) has been consistently recognized as a protective factor for cardiovascular diseases (CVD) and all-cause mortality. However, the pattern of this relationship is still not clear. The aim of this study was to assess the relationship of LTPA with incident CVD and mortality in a Spanish population. A prospective population-based cohort of 11 158 randomly selected inhabitants from the general population. LTPA was assessed by a validated questionnaire. Mortality and CVD outcomes were registered during the follow-up (median: 7.24 years). The association between LTPA and outcomes of interest (all-cause mortality and cardiovascular disease) was explored using a generalized additive model with penalized smoothing splines and multivariate Cox proportional hazard models. We observed a significant nonlinear association between LTPA and all-cause and CVD mortality, and fatal and nonfatal CVD. Moderate-vigorous intensity LTPA, but not light-intensity LTPA, were associated with beneficial effects. The smoothing splines identified a cutoff at 400 MET-min/d. Below this threshold, each increase of 100 MET-min/d in moderate-vigorous LTPA contributed with a 16% risk reduction in all-cause mortality (HR, 0.84; 95%CI, 0.77-0.91), a 27% risk reduction in CVD mortality (HR, 0.73; 95%CI, 0.61-0.87), and a 12% risk reduction in incident CVD (HR, 0.88; 95%CI, 0.79-0.99). No further benefits were observed beyond 400 MET-min/d. Our results support a nonlinear inverse relationship between moderate-vigorous LTPA and CVD and mortality. Benefits of PA are already observed with low levels of activity, with a maximum benefit around 3 to 5 times the current recommendations. Copyright © 2021 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

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