Physical activity and risk of instant and 28-day case-fatality in myocardial infarction

Patterns among factors associated with myocardial infarction: chi-squared automatic interaction detection tree and binary logit model

BACKGROUND

Although mortality from myocardial infarction (MI) has declined worldwide due to advancements in emergency medical care and evidence-based pharmacological treatments, MI remains a significant contributor to global cardiovascular morbidity. This study aims to examine the risk factors associated with individuals who have experienced an MI in Türkiye.

METHODS

Microdata obtained from the Türkiye Health Survey conducted by Turkish Statistical Institute in 2019 were used in this study. Binary logistic regression, Chi-Square, and CHAID analyses were conducted to identify the risk factors affecting MI.

RESULTS

The analysis identified several factors associated with an increased likelihood of MI, including hyperlipidemia, hypertension, diabetes, chronic disease status, male gender, older age, single marital status, lower education level, and unemployment. Marginal effects revealed that elevated hyperlipidemia levels increased the probability of MI by 4.6%, while the presence of hypertension, diabetes, or depression further heightened this risk. Additionally, individuals with chronic diseases lasting longer than six months were found to have a higher risk of MI. In contrast, factors such as being female, having higher education, being married, being employed, engaging in moderate physical activity, and moderate alcohol consumption were associated with a reduced risk of MI.

CONCLUSION

To prevent MI, emphasis should be placed on enhancing general education and health literacy. There should be a focus on increasing preventive public health education and practices to improve variables related to healthy lifestyle behaviours, such as diabetes, hypertension, and hyperlipidemia.

Associations between physical activity and heart disease among middle-aged and older Chinese adults

Objective

To quantify the risk of heart diseases (HD) and determine the relationship between physical activity (PA) dimensions and HD among Chinese middle-aged and older individuals.

Methods

Using data from the China Health and Retirement Longitudinal Study (CHARLS, 2018), 16,927 participants were included in this study. Multivariate logistic regression was performed to determine the association between HD risk and PA dimensions, including volume, intensity, frequency, and duration. Restricted cubic spline analysis was conducted to assess the dose-response relationship between PA and HD risk.

Results

Compared to the least active participants, a low risk of HD was significantly associated with a higher PA volume. With regards to frequency, a lower HD risk was associated with performing vigorous PA except for 3-5 days/week. The frequency and duration of light as well as moderate PA had no significant associations with HD risk after adjusted by using covariates. A non-linear association was also noted, with increased PA being associated with decreased HD risk, with steeper reductions in HD risk at low activity levels than at high activity levels. There was a non-linear association between PA and HD risk in participants in male and aged older than 65 years.

Conclusions

An inverse non-linear dose-response association was detected between the total volume of PA and HD risk. As PA increased to 4,000 METs-min/week, HD risk in the overall population decreased by approximately 26%, while further increases in PA did not produce any further marked reduction in the risk. A vigorous intensity of PA was associated with a reduced risk of HD and is strongly recommended.

Premorbid physical activity and prognosis after incident myocardial infarction: The atherosclerosis risk in communities study

BACKGROUND

High to moderate levels of physical activity (PA) are associated with low risk of incident cardiovascular disease. However, it is unclear whether the benefits of PA in midlife extend to cardiovascular health following myocardial infarction (MI) in later life.

METHODS

Among 1,111 Atherosclerosis Risk in Communities study participants with incident MI during Atherosclerosis Risk in Communities follow-up (mean age 73 [SD 9] years at MI, 54% men, 21% Black), PA on average 11.9 (SD 6.9) years prior to incident MI (premorbid PA) was evaluated as the average score of PA between visit 1 (1987-1989) and visit 3 (1993-1995) using a modified Baecke questionnaire. Total and domain-specific PA (sport, nonsport leisure, and work PA) was analyzed for associations with composite and individual outcomes of mortality, recurrent MI, and stroke after index MI using multivariable Cox models.

RESULTS

During a median follow-up of 4.6 (IQI 1.0-10.5) years after incident MI, 823 participants (74%) developed a composite outcome. The 10-year cumulative incidence of the composite outcome was lower in the highest, as compared to the lowest tertile of premorbid total PA (56% vs. 70%, respectively). This association remained statistically significant even after adjusting for potential confounders (adjusted hazard ratio [aHR] 0.80 [0.67-0.96] for the highest vs. lowest tertile). For individual outcomes, high premorbid total PA was associated with a low risk of recurrent MI (corresponding aHR 0.64 [0.44, 0.93]). When domain-specific PA was analyzed, similar results were seen for sport and work PA. The association was strongest in the first year following MI (e.g., aHR of composite outcome 0.66 [95% CI 0.47, 0.91] for the highest vs. lowest tertile of total PA).

CONCLUSIONS

Premorbid PA was associated positively with post-MI cardiovascular health. Our results demonstrate the additional prognostic advantages of PA beyond reducing the risk of incident MI.

Postacute Myocardial Infarction Differences in Physical Activity Behavior, Anxiety, and Depression Levels

Background

There are limited studies regarding physical activity, anxiety, and depression levels among patients with postacute myocardial infarction (AMI). This is a need for more research on physical activity, anxiety, and depression levels based on the type of AMI following hospitalization to develop interventions to improve these outcomes.

Objective

To compare physical activity behavior, anxiety, and depression levels among patients with post-ST-elevation myocardial infarction (STEMI) and post-non-ST-elevation myocardial infarction (NSTEMI) not involved in cardiac rehabilitation program following hospitalization.

Methods

A descriptive cross-sectional study design was employed with a convenience sample of 254 patients with post-AMI, 4 weeks after hospitalization. Participants, recruited from three hospitals in Jordan.

Results

The sample characteristics included the following: 140 males (54.3%), 120 married (47.2%), diagnosed with STEMI (n = 137, 53.1%) or NSTEMI (n = 117, 45.3%). And 41.3% of participants had moderate-to-severe anxiety level (General Anxiety Disorder-7 [GAD-7] > 10), while 22.0% had moderate to severe depression levels (Patient Health Questionnaire-9 [PHQ-9] > 10). Post-STEMI and post-NSTEMI participants had moderate levels of anxiety, with 14.39 (3.45) versus 13.37 (3.51); and depression levels of 12.66 (3.28) versus 12.22 (3.54), respectively. There was no significant difference in depression level between patients with post-STEMI and post-NSTEMI, but the former had statistically significant higher anxiety level than the latter. The mean self-reported exercise duration and exercise frequency of patients with post-STEMI were significantly higher than for their post-NSTEMI counterparts: 151.7 (76.33) versus 87.78 (37.62) minutes per week, and 2.92 (1.44) versus 1.97 (0.88) times per week (respectively). Furthermore, patients with post-STEMI had less mean sedentary time: 582.92 (128.92) and 641.54 (147. 27) minutes per day (p > .05) (respectively).

Conclusions

Healthcare providers have to consider the differences in physical activity behavior, anxiety, depression levels based on types of AMI when developing interventions and establishing cardiac rehabilitation program to improve physical activity behavior and reducing sedentary time.

Association between engagement in exercise training and peak cardiac biomarker concentrations following ST-elevation myocardial infarction

Background

Regular exercise training is an important factor in prevention of myocardial infarction (MI). However, little is known whether exercise engagement prior to MI is related to the magnitude of post-MI cardiac biomarker concentrations and clinical outcomes.

Objectives

We tested the hypothesis that exercise engagement in the week prior MI is related to lower cardiac biomarker concentrations following ST-elevated MI (STEMI).

Methods

We recruited hospitalised STEMI patients and assessed the amount of exercise engagement in the 7 days preceding MI onset using a validated questionnaire. Patients were classified as 'exercise' if they performed any vigorous exercise in the week prior MI, or as 'control' if they did not. Post-MI peak concentrations of high-sensitive cardiac troponin T (peak-hs-cTnT) and creatine kinase (peak-CK) were examined. We also explored whether exercise engagement prior MI is related to the clinical course (duration of hospitalisation and incidence of in-hospital, 30-day and 6-month major adverse cardiac events (reinfarction, target vessel revascularisation, cardiogenic shock or death)).

Results

In total, 98 STEMI patients were included, of which 16% (n=16) was classified as 'exercise', and 84% (n=82) as 'control'. Post-MI peak-hs-cTnT and peak-CK concentrations were lower in the exercise group (941 (645-2925) ng/mL; 477 (346-1402) U/L, respectively) compared with controls (3136 (1553-4969) ng/mL, p=0.010; 1055 (596-2019) U/L, p=0.016, respectively). During follow-up, no significant differences were found between both groups.

Conclusion

Engagement in exercise is associated with lower cardiac biomarker peak concentrations following STEMI. These data could provide further support for the cardiovascular health benefits of exercise training.

Molecular Mechanisms of Exercise and Healthspan

Healthspan is the period of our life without major debilitating diseases. In the modern world where unhealthy lifestyle choices and chronic diseases taper the healthspan, which lead to an enormous economic burden, finding ways to promote healthspan becomes a pressing goal of the scientific community. Exercise, one of humanity's most ancient and effective lifestyle interventions, appears to be at the center of the solution since it can both treat and prevent the occurrence of many chronic diseases. Here, we will review the current evidence and opinions about regular exercise promoting healthspan through enhancing the functionality of our organ systems and preventing diseases.

Association of fatal myocardial infarction with past level of physical activity: a pooled analysis of cohort studies

AIMS

To assess the association between past level of physical activity (PA) and risk for death during the acute phase of myocardial infarction (MI) in a pooled analysis of cohort studies.

METHODS AND RESULTS

European cohorts including participants with a baseline assessment of PA, conventional cardiovascular (CV) risk factors, and available follow-up on MI and death were eligible. Patients with an incident MI were included. Leisure-time PA was grouped as sedentary (<7 MET-hours), low (7-16 MET-hours), moderate (16.1-32 MET-hours), or high (>32 MET-hours) based on calculated net weekly energy expenditure. The main outcome measures were instant and 28-day case fatality of MI. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using multivariate random-effects models. Adjustments for age, sex, CV risk factors, alcohol consumption, and socioeconomic status were made. From 10 cohorts including a total of 1 495 254 participants, 28 140 patients with an incident MI comprised the study population. A total of 4976 (17.7%) died within 28 days-of these 3101 (62.3%) were classified as instant fatal MI. Compared with sedentary individuals, those with a higher level of PA had lower adjusted odds of instant fatal MI: low PA [OR, 0.79 (95% CI, 0.60-1.04)], moderate PA [0.67 (0.51-0.89)], and high PA [0.55 (0.40-0.76)]. Similar results were found for 28-day fatal MI: low PA [0.85 (0.71-1.03)], moderate PA [0.64 (0.51-0.80)], and high PA [0.72 (0.51-1.00)]. A low-to-moderate degree of heterogeneity was detected in the analysis of instant fatal MI (I2 = 47.3%), but not in that of 28-day fatal MI (I2 = 0.0%).

CONCLUSION

A moderate-to-high level of PA was associated with a lower risk of instant and 28-day death in relation to a MI.

Exercise and cardiac health: physiological and molecular insights

The cardiac benefits of exercise have been recognized for centuries. Studies have undisputedly shown that regular exercise is beneficial for the cardiovascular system in young, old, healthy and diseased populations. For these reasons, physical activity has been recommended worldwide for cardiovascular disease prevention and treatment. Although the benefits of exercise are clear, understanding of the molecular triggers that orchestrate these effects remains incomplete and has been a topic of intense research in recent years. Here, we provide a comprehensive review of the cardiac effects of physical activity, beginning with a brief history of exercise in cardiovascular medicine and then discussing seminal work on the physiological effects of exercise in healthy, diseased and aged hearts. Later, we revisit pioneering work on the molecular mechanisms underlying the cardiac benefits of exercise, and we conclude with our view on the translational potential of this knowledge as a powerful platform for cardiovascular disease drug discovery.

Prior exercise training and experimental myocardial infarction: A systematic review and meta-analysis

Exercising prior to experimental infarction may have beneficial effects on the heart. The objective of this study was to analyze studies on animals that had exercised prior to myocardial infarction and to examine any benefits through a systematic review and meta-analysis. The databases MEDLINE, Google Scholar, and Cochrane were consulted. We analyzed articles published between January 1978 and November 2018. From a total of 858 articles, 13 manuscripts were selected in this review. When animals exercised before experimental infarction, there was a reduction in mortality, a reduction in infarct size, improvements in cardiac function, and a better molecular balance between genes and proteins that exhibit cardiac protective effects. Analyzing heart weight/body weight, we observed the following results - Mean difference 95% CI - -0.02 [-0.61,0.57]. Meta-analysis of the infarct size (% of the left ventricle) revealed a statistically significant decrease in the size of the infarction in animals that exercised before myocardial infarction, in comparison with the sedentary animals -5.05 [-7.68, -2.40]. Analysis of the ejection fraction, measured by echo (%), revealed that animals that exercised before myocardial infarction exhibited higher and statistically significant measures, compared with sedentary animals 8.77 [3.87,13.66]. We conclude that exercise performed prior to experimental myocardial infarction confers cardiac benefits to animals.