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Physical Activity and Cardiovascular Disease
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. (Cardiovascular Epidemiology)ORCID iD: 0000-0002-6534-2613
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aim was to investigate associations of fitness and types and levels of physical activity with subsequent risk of cardiovascular disease.

Four large-scale longitudinal cohort studies were used. The exposures were different measures related to physical activity and the outcomes were obtained through linkage to the Swedish In-Patient Register. In a cohort of 466 elderly men without pre-existing cardiovascular disease, we found that skeletal muscle morphology was associated with risk of cardiovascular events. A high amount of type I (slow-twitch, oxidative) skeletal muscle fibres was associated with lower risk of cardiovascular events and high amount of type IIx was associated with higher risk of cardiovascular events. This association was only seen among physically active men. Among 39,805 participants in a fundraising event, higher levels of both total and leisure time physical activity were associated with lower risk of heart failure. The associations were strongest for leisure time physical activity. In a cohort of 53,755 participants in the 90 km skiing event Vasaloppet, a higher number of completed races was associated with higher risk of atrial fibrillation and a higher risk of bradyarrhythmias. Further, better relative performance was associated with a higher risk of bradyarrhythmias. Among 1,26 million Swedish 18-year-old men, exercise capacity and muscle strength were independently associated with lower risk of vascular disease. The associations were seen across a range of major vascular disease events (ischemic heart disease, heart failure, stroke and cardiovascular death). Further, high exercise capacity was associated with higher risk of atrial fibrillation and a U-shaped association with bradyarrhythmias was found. Higher muscle strength was associated with lower risk of bradyarrhythmias and lower risk of ventricular arrhythmias.

These findings suggest a higher rate of atrial fibrillation with higher levels of physical activity. The higher risk of atrial fibrillation does not appear to lead to a higher risk of stroke. In contrast, we found a strong inverse association of higher exercise capacity and muscle strength with vascular disease. Further, high exercise capacity and muscle strength are related to lower risk of cardiovascular death, including arrhythmia deaths. From a population perspective, the total impact of physical activity on cardiovascular disease is positive.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2014. , 84 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 972
Keyword [en]
Physical activity, epidemiology, cohort study, heart failure, cardiovascular disease, arrhythmias, atrial fibrillation, bradyarrhythmias, sudden cardiac death, heart failure, stroke, ischemic heart disease, cardiovascular death, maximal exercise capacity, muscle strength, skeletal muscle morphology
National Category
Cardiac and Cardiovascular Systems
Research subject
Cardiology; Epidemiology
Identifiers
URN: urn:nbn:se:uu:diva-217309ISBN: 978-91-554-8871-0 (print)OAI: oai:DiVA.org:uu-217309DiVA: diva2:692783
Public defence
2014-03-21, Enghoffsalen, Akademiska Sjukhuset, Ing 50, Uppsala, 13:15 (Swedish)
Opponent
Supervisors
Available from: 2014-02-27 Created: 2014-02-01 Last updated: 2014-04-29
List of papers
1. Skeletal muscle morphology and risk of cardiovascular disease in elderly men
Open this publication in new window or tab >>Skeletal muscle morphology and risk of cardiovascular disease in elderly men
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2015 (English)In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 22, no 2, 231-239 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

While it is well known that physical inactivity is a major risk factor for cardiovascular disease, there is still a search for the mechanisms by which exercise exerts its positive effect. Skeletal muscle fibre type can be affected to some extent by exercise, and different fibre types possess different anti-inflammatory and glucometabolic properties that may influence cardiovascular disease risk.

DESIGN:

Population-based cohort study.

METHODS:

We investigated relations of skeletal muscle morphology to risk of cardiovascular events in a sample of 466 71-year-old men without cardiovascular disease, of which 295 were physically active (strenuous physical activity at least 3 h/week).

RESULTS:

During a median of 13.1 years of follow up, 173 major cardiovascular events occurred. Among physically active men, 10% higher proportion of type-I (slow-twitch oxidative) fibres was associated with a hazard ratio (HR) of 0.84 (95% confidence interval 0.74-0.95) for cardiovascular events, and 10% higher proportion of type-IIx (fast-twitch glycolytic) fibres was associated with a HR of 1.24 (1.06-1.45), adjusting for age. Similar results were observed in several sets of multivariable-adjusted models. No association of muscle fibre type with risk of cardiovascular events was observed among physically inactive men.

CONCLUSIONS:

Higher skeletal muscle proportion of type-I fibres was associated with lower risk of cardiovascular events and a higher proportion of type-IIx fibres was associated with higher risk of cardiovascular events. These relations were only observed in physically active men. Skeletal muscle fibre composition may be a mediator of the protective effects of exercise against cardiovascular disease.

National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-210441 (URN)10.1177/2047487313506828 (DOI)000348115400014 ()24092874 (PubMedID)
Available from: 2013-11-08 Created: 2013-11-08 Last updated: 2017-12-06Bibliographically approved
2. Dose–Response Relationship of Total and Leisure Time Physical Activity to Risk of Heart Failure: a prospective cohort study
Open this publication in new window or tab >>Dose–Response Relationship of Total and Leisure Time Physical Activity to Risk of Heart Failure: a prospective cohort study
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2014 (English)In: Circulation Heart Failure, ISSN 1941-3289, E-ISSN 1941-3297, Vol. 7, no 5, 16 p.701-708 p.Article in journal (Refereed) Published
Abstract [en]

Background—The nature of the association between levels of physical activity and risk of heart failure is little known. We investigated nonlinear associations of total and leisure time physical activity with risk of heart failure.

Methods and Results—In 1997, 39 805 persons without heart failure completed a questionnaire of lifestyle factors and medical history. We used Cox regression models to investigate total (adjusting for education and previous myocardial infarction) and direct (multivariable-adjusted) effects of self-reported total and leisure time physical activity on risk of heart failure of any cause and heart failure of nonischemic origin. Heart failure diagnoses were obtained until December 31, 2010. Higher leisure time physical activity was associated with lower risk of heart failure of any cause; hazard ratio of the total effect of leisure time physical activity was for fifth versus first quintile 0.54; 95% confidence interval was 0.44 to 0.66. The direct effect was similar. High total daily physical activity level was associated with lower risk of heart failure, although the effect was less pronounced than for leisure time physical activity (total effect hazard ratio, 0.81; 95% confidence interval, 0.69–0.95; fifth versus first quintile). A similar direct effect observed.

Conclusions—Leisure time physical activity was inversely related to risk of developing heart failure in a dose–response fashion. This was reflected in a similar but less pronounced association of total physical activity with risk of heart failure. Only part of the effects appeared to be mediated by traditional risk factors.

Publisher
16 p.
Keyword
heart failure, physical exercise, cohort study, primary prevention, epidemiology
National Category
Cardiac and Cardiovascular Systems
Research subject
Cardiology; Epidemiology
Identifiers
urn:nbn:se:uu:diva-216862 (URN)10.1161/CIRCHEARTFAILURE.113.001010 (DOI)000342490900003 ()25185250 (PubMedID)
Available from: 2014-02-01 Created: 2014-01-27 Last updated: 2017-12-06Bibliographically approved
3. Risk of arrhythmias in 52 755 long-distance cross-country skiers: a cohort study
Open this publication in new window or tab >>Risk of arrhythmias in 52 755 long-distance cross-country skiers: a cohort study
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2013 (English)In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 34, no 47, 3624-3631 p.Article in journal (Refereed) Published
Abstract [en]

AIMS:

We aimed to investigate the association of number of completed races and finishing time with risk of arrhythmias among participants of Vasaloppet, a 90 km cross-country skiing event.

METHODS AND RESULTS:

All the participants without cardiovascular disease who completed Vasaloppet during 1989-98 were followed through national registries until December 2005. Primary outcome was hospitalization for any arrhythmia and secondary outcomes were atrial fibrillation/flutter (AF), bradyarrhythmias, other supraventricular tachycardias (SVT), and ventricular tachycardia/ventricular fibrillation/cardiac arrest (VT/VF/CA). Among 52 755 participants, 919 experienced arrhythmia during follow-up. Adjusting for age, education, and occupational status, those who completed the highest number of races during the period had higher risk of any arrhythmias [hazard ratio (HR)1.30; 95% CI 1.08-1.58; for ≥5 vs. 1 completed race], AF (HR 1.29; 95% CI 1.04-1.61), and bradyarrhythmias (HR 2.10; 95% CI 1.28-3.47). Those who had the fastest relative finishing time also had higher risk of any arrhythmias (HR 1.30; 95% CI 1.04-1.62; for 100-160% vs. >240% of winning time), AF (1.20; 95% CI 0.93-1.55), and bradyarrhythmias (HR 1.85; 95% CI 0.97-3.54). SVT or VT/VF/CA was not associated with finishing time or number of completed races.

CONCLUSIONS:

Among male participants of a 90 km cross-country skiing event, a faster finishing time and a high number of completed races were associated with higher risk of arrhythmias. This was mainly driven by a higher incidence of AF and bradyarrhythmias. No association with SVT or VT/VF/CA was found.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-205089 (URN)10.1093/eurheartj/eht188 (DOI)000329134300012 ()23756332 (PubMedID)
Available from: 2013-08-13 Created: 2013-08-13 Last updated: 2017-12-06Bibliographically approved
4. Exercise capacity and muscle strength and risk of vascular disease and arrhythmias: A cohort study of 1.26 million young men
Open this publication in new window or tab >>Exercise capacity and muscle strength and risk of vascular disease and arrhythmias: A cohort study of 1.26 million young men
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

Background:

While physical activity and exercise protects against cardiovascular disease, athletes have higher risk of atrial fibrillation and other arrhythmias. Graded independent and joint influences of exercise capacity and muscle strength on these diseases are unknown.

Methods:

All 1.26 million Swedish men who participated in mandatory military conscription between 1972 and 1995 (at a median age of 18.2 years) contributed. Multivariable-adjusted Cox proportional hazards models were used to evaluate the associations of maximal exercise capacity and muscle strength at conscription to subsequent risk of vascular disease and arrhythmias, as identified in national registries.

Results:

During a median follow-up of 26.3 years, about 26,000 hospitalizations for vascular disease events and 17,000 for arrhythmias occurred. Exercise capacity was inversely associated with risk of vascular disease (hazard ratio [HR] 0.64; 95% confidence interval [CI] 0.61-0.67]; for 5th vs. 1st quintile) and so was muscle strength (HR 0.79; 0.76-0.83; for 5th vs. 1st quintile ). Similar associations were seen across a range of major vascular disease events. Exercise capacity was associated with incidence of arrhythmias in a U-shaped fashion (HR 0.91; 0.86-0.96; for 3rd vs. 1st quintile, and 0.99; 0.94-1.04; for 5th vs. 1st quintile). Higher muscle strength was associated with lower risk of arrhythmias (HR 0.87; 0.83-0.91; for 5th vs. 1st quintile). 

Conclusion:

Exercise capacity and muscle strength in late adolescence are independently and jointly associated with long-term risk of vascular disease and arrhythmias. The lower risk of vascular events with higher exercise capacity was not outweighed by higher risk of arrhythmias.

National Category
Medical and Health Sciences Cardiac and Cardiovascular Systems
Research subject
Cardiology; Epidemiology
Identifiers
urn:nbn:se:uu:diva-217308 (URN)
Available from: 2014-02-01 Created: 2014-02-01 Last updated: 2016-01-18Bibliographically approved

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