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Risk of Recurrent Stroke and Death After First Stroke in Long‐Distance Ski Race Participants
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.ORCID iD: 0000-0003-2146-7382
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology. Högskolan Dalarna Falun.
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2015 (English)In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, ISSN 2047-9980, E-ISSN 2047-9980, Vol. 4, no 10, e002469Article in journal (Refereed) Published
Abstract [en]

Background Physical activity is of benefit for primary prevention of cardiovascular diseases, but it appears to increase the risk for atrial fibrillation. We aimed to study a cohort of patients following a first stroke in individuals with previous high physical activity, compare them to the general population with respect to recurrent stroke and death, and relate these to atrial fibrillation.

Methods and Results From the participants of the Vasaloppet, the world's largest ski‐race, and matched individuals from the general population (n=708 604), we identified 5964 patients hospitalized with a first‐time stroke between 1994 and 2010. Individuals with severe diseases were excluded. One half percent of skiers and 1% of nonskiers were hospitalized due to stroke. The incidence rate was 8.3 per 100 person‐years among skiers and 11.1 among nonskiers. The hazard ratio (HR) for recurrent stroke or death between the 2 groups was 0.76 (95% CI 0.67 to 0.86). The result was consistent in subgroups. The HR for death was 0.66 (95% CI 0.56 to 0.78) and for recurrent stroke 0.82 (95% CI 0.70 to 0.96). After adjustment for smoking and socioeconomic factors, the HR for death was consistent at 0.70 (95% CI 0.56 to 0.87) while the HR for recurrent stroke was not statistically significant. Outcomes for skiers with atrial fibrillation tended to show a lower risk than for nonskiers.

Conclusions This large cohort study supports the hypothesis that patients with a stroke and with prior regular physical activity have a lower risk of death, while their risk for recurrent stroke is similar to that of nonskiers. The skiers had a higher incidence of atrial fibrillation, but still no increased risk of recurring stroke.

Place, publisher, year, edition, pages
2015. Vol. 4, no 10, e002469
Keyword [en]
atrial fibrillation; cerebrovascular disease; cross-country skiing; epidemiology; lifestyle; physical activity; prevention; recurrent stroke; sports medicine; Sweden; Vasaloppet
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Epidemiology
Identifiers
URN: urn:nbn:se:uu:diva-260198DOI: 10.1161/JAHA.115.002469ISI: 000364153000039OAI: oai:DiVA.org:uu-260198DiVA: diva2:846626
Available from: 2015-08-17 Created: 2015-08-17 Last updated: 2017-12-04Bibliographically approved
In thesis
1. Epidemiological Studies on Long Distance Cross-Country Skiers: Participants in the Vasaloppet 1955-2010
Open this publication in new window or tab >>Epidemiological Studies on Long Distance Cross-Country Skiers: Participants in the Vasaloppet 1955-2010
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to study the influence of physical activity on health. Risks and benefits of physical activity is of particular interest since there is a global trend of less physical activity among youths and adults.

In order to investigate this aim we used a database from a large cross country ski race, Vasaloppet, with participants with a wide age range, and with both elite athletes and ordinary people who exercise and promote their health. The most serious risk of strenuous exercise is sudden death and it is challenging to identify preventive effects of major endemic diseases.

Using epidemiological methodology we studied 200 000 Vasaloppet skiers and compared them with the general population. Based on personal identification numbers we added data from Swedish national personal and health registers, clinical registers as the cancer register, Swedeheart, or Swedish stroke register, and socioeconomic information from Statistics Sweden. In the Vasaloppet database we collected data on age, gender, finish time and number of races during the period 1989 to 2010.

We evaluated risk of death during the race in two papers (I,II). During 90 years of annual races, cardiac arrest occurred in 20 skiers, of which five survived. The death rate is in average two per 100 000 skiers.

We also studied the association with cancer incidence (paper III). The overall reduction of cancer was modest among skiers compared with the general population, but for cancers related to lifestyle the risks were markedly lower.

We investigated the risk for recurrent myocardial infarction and found a 30% reduction among skiers (paper IV). In paper V we showed that skiers with a first stroke have a lower incidence of all-cause death. The skiers had a higher frequency of atrial fibrillation but had less severe stroke and no increased risk of recurrent stroke. Thus our data suggest that a lifestyle with a high level of physical activity may work as a protection after a cardiovascular event.

Summary: The short excess mortality in endurance physical activity is by far outweighed by the long term protective effect of exercise in cardiovascular diseases and cancer.

 

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2015. 108 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1132
Keyword
Epidemiology, Cohort study, Physical activity, Lifestyle, Prevention, Sports medicine, Cancer, Cardiovascular disease, Mortality, Cardiac arrest, Atrial fibrillation, Myocardial infarction, Stroke, Cross-Country skiing, Vasaloppet, Sweden
National Category
Medical and Health Sciences
Research subject
Epidemiology
Identifiers
urn:nbn:se:uu:diva-260994 (URN)978-91-554-9324-0 (ISBN)
Public defence
2015-10-22, Enghoffsalen, ingång 50, Akademiska sjukhuset, Uppsala, 13:00 (Swedish)
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Supervisors
Available from: 2015-09-30 Created: 2015-08-27 Last updated: 2015-10-01

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Hållmarker, UlfÅsberg, SignildMichaëlsson, KarlÄrnlöv, JohanHellberg, DanLindbäck, JohanJames, Stefan K.
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