目的:体力活动已被证明可有效预防动脉粥样硬化性心血管疾病,但其在预防退行性心脏瓣膜病(VHD)中的作用仍不确定.这项研究旨在探讨中年人中中等至剧烈体力活动(MVPA)量与退行性VHD风险之间的剂量反应关系。
方法:将2013年至2015年来自87248名UKBiobank参与者(中位年龄63.3,女性:56.9%)的加速度计得出的MVPA数据用于主要分析。2006年至2010年间,来自361681名英国生物银行参与者(中位年龄57.7岁,女性:52.7%)的问卷衍生的MVPA数据用于二次分析。主要结果是诊断为退行性VHD,包括主动脉瓣狭窄(AS),主动脉瓣反流(AR),和二尖瓣反流(MR)。次要结果是VHD相关干预或死亡率。
结果:在加速度计衍生的MVPA队列中,555事件AS,201事件AR,中位随访时间为8.11年,有655例MR发生.增加的MVPA量显示AS风险和随后的AS相关干预或死亡风险稳步下降,整平超过约300分钟/周。相比之下,其与AR或MR发生率的关联不太明显.MVPA四分位数(Q1-Q4)的AS发生率(95%置信区间)调整后为11.60(10.20,13.20),7.82(6.63,9.23),5.74(4.67,7.08),和5.91(4.73,7.39)每10000人年。相应的调整后AS相关干预或死亡率为4.37(3.52,5.43),2.81(2.13,3.71),1.93(1.36,2.75),和2.14(1.50,3.06)每10000人年,分别。主动脉瓣狭窄风险降低也观察到基于问卷的MVPA数据[调整后的绝对差异Q4与Q1:AS发生率,每10000人年-1.41(-.67,-2.14);与AS相关的干预或死亡率,每10000人年-.38(-.04,-.88)]。在AS的高危人群中,有益的关联保持一致,包括高血压患者,肥胖,血脂异常,和慢性肾病。
结论:较高的MVPA体积与较低的AS发病风险和随后的AS相关干预或死亡率相关。未来的研究需要在持续时间更长和活动监测重复周期的不同人群中验证这些发现。
OBJECTIVE: Physical activity has proven effective in preventing atherosclerotic cardiovascular disease, but its role in preventing degenerative valvular heart disease (VHD) remains uncertain. This study aimed to explore the dose-response association between moderate to vigorous physical activity (MVPA) volume and the risk of degenerative VHD among middle-aged adults.
METHODS: A full week of accelerometer-derived MVPA data from 87 248 UK Biobank participants (median age 63.3, female: 56.9%) between 2013 and 2015 were used for primary analysis. Questionnaire-derived MVPA data from 361 681 UK Biobank participants (median age 57.7, female: 52.7%) between 2006 and 2010 were used for secondary analysis. The primary outcome was the diagnosis of incident degenerative VHD, including aortic valve stenosis (AS), aortic valve regurgitation (AR), and mitral valve regurgitation (MR). The secondary outcome was VHD-related intervention or mortality.
RESULTS: In the accelerometer-derived MVPA cohort, 555 incident AS, 201 incident AR, and 655 incident MR occurred during a median follow-up of 8.11 years. Increased MVPA volume showed a steady decline in AS risk and subsequent AS-related intervention or mortality risk, levelling off beyond approximately 300 min/week. In contrast, its association with AR or MR incidence was less apparent. The adjusted rates of AS incidence (95% confidence interval) across MVPA quartiles (Q1-Q4) were 11.60 (10.20, 13.20), 7.82 (6.63, 9.23), 5.74 (4.67, 7.08), and 5.91 (4.73, 7.39) per 10 000 person-years. The corresponding adjusted rates of AS-related intervention or mortality were 4.37 (3.52, 5.43), 2.81 (2.13, 3.71), 1.93 (1.36, 2.75), and 2.14 (1.50, 3.06) per 10 000 person-years, respectively. Aortic valve stenosis risk reduction was also observed with questionnaire-based MVPA data [adjusted absolute difference Q4 vs. Q1: AS incidence, -1.41 (-.67, -2.14) per 10 000 person-years; AS-related intervention or mortality, -.38 (-.04, -.88) per 10 000 person-years]. The beneficial association remained consistent in high-risk populations for AS, including patients with hypertension, obesity, dyslipidaemia, and chronic kidney disease.
CONCLUSIONS: Higher MVPA volume was associated with a lower risk of developing AS and subsequent AS-related intervention or mortality. Future research needs to validate these findings in diverse populations with longer durations and repeated periods of activity monitoring.