Association Of Physical Activity With Ventricular Remodeling And Mortality Risk In High Cardiovascular Risk Population

Part Ⅰ:Association between Physical Activity with Ventricular Structure and Remodeling in High Cardiovascular Risk Population:A Cross-sectional StudyBackground:Physical activity(PA)is associated with cardiac remodeling.The majority of previous studies have focused on the effect of specific exercise training intensity on benign cardiac remodeling in healthy athletes.Individuals in high cardiovascular risk are advised to increase their physical activity as a crucial lifestyle intervention strategy.However,systematic research on the effects of diverse levels and types of physical activity on ventricular structure parameters and ventricular remodeling is lacking.Objective:To investigate associations between volumes of total physical activity(TPA),vigorous physical activity(VPA),patterns of physical activity and ventricular structure parameters and ventricular remodeling.Method:Based on the ChinaHEART(Health Evaluation And risk Reduction through nationwide Teamwork),this study included community residents aged 35-75 years from 2014-2021 who had a 10-year ASCVD risk assessment≥10%according to the World Health Organization’s in 2019 and additionally,with complete data on both left and right ventricular structural parameters.A validated questionnaire was used to collect information on physical activity.TPA was defined as the total Metabolic equivalent task(MET)of all patterns of physical activity and divided into three groups:low(2000 MET-min/week),moderate(2000-5000 MET-min/week),and high(>5000 MET-min/week).Based on the MET value corresponding to each physical activity,VPA was defined as physical activity with an intensity of>6MET and was divided into three groups by activity level:low level(100 MET-min/week),medium level(100-500 MET-min/week),and high level(>500 MET-min/week).The patterns of physical activity included leisure time activities(LTPA),housework,occupational(HPA),and transportation activities(TsPA).Ventricular structural parameters included left ventricular end-diastolic diameter,ventricular septal thickness,left ventricular posterior wall thickness,and left ventricular mass index,right ventricular anteroposterior diameter.Left ventricular remodeling was defined as including concentric remodeling,concentric hypertrophy,and eccentric hypertrophy.Right ventricular remodeling was defined as right ventricular anteroposterior diameter≥25mm.Restricted cubic splines and multiple logistic regression models were used to analyse the dose-response relationship between physical activity and ventricular structural parameters and ventricular remodeling.Models were adjusted for age,gender,level of education,family income,urban and rural locations,smoking status,alcohol consumption status,metabolic abnormalities,and medication information.Results:A total of 161,803 participants were included,with a median age of 63(interquartile range:58-68)years,and 55.1%of those were female.There were 94,579 participants with left ventricular structure remodeling(58.5%)and 65,457 with right ventricular structure remodeling(40.5%).Positive nonlinear dose-response associations were observed between TPA with left and right ventricular structure parameters(P non-linear<0.001),as well as vigorous physical activity(VPA)and left and right ventricular structure parameters(P non-linear<0.001).1.Compared to low TPA,high TPA was associated with left ventricular remodeling(OR 1.12,95%CI 1.09-1.15).TPA in the hypertensive population was significantly more correlated with left ventricular structural parameters than in the non-hypertensive population(LVEDD:P interaction<0.013,IVST:Pinteraction=0.006,LVPWT:P interaction=0.026,LVMI:P interaction=0.016<0.001).In the diabetic population,correlations between TPA and right ventricular structure parameters were lower than in non-diabetic population(RVEDD:P interaction<0.001).2.Moderate VPA was associated with a decreased left ventricular remodeling risk compared with low VPA(OR 0.90,95%CI:0.87-0.92),and high VPA was marginally associated with left ventricular remodeling risk(OR 1.03,95%CI:1.00-1.06).However,moderate and high VPA were lightly associated with the right ventricular remodeling risk(moderate:OR 1.05,95%CI:1.02-1.08;high:OR 1.04,95%CI:1.02-1.07).3.Among physical activity types,compared with low LTPA,the moderate and high were significantly associated with a decreased left ventricular remodeling risk(moderate:OR 0.84,95%CI:0.82-0.87;high:OR 0.94,95%CI:0.92-0.99).Compared with low OPA/TsPA,moderate and high OPA/TsPA were marginally associated with the left ventricular remodeling risk(moderate:OR 1.14,95%CI:1.10-1.18;high:OR 1.11,95%CI:1.08-1.15).Nonetheless,left ventricular remodeling risk was found to be only weakly associated with household activity.(moderate:OR 1.00,95%CI:0.98-1.03;high:OR 1.05,95%CI:1.01-1.08).Conclusion:In high cardiovascular risk population,both volumes of TPA and VPA exhibited nonlinear correlations with ventricular structure parameters.High TPA was associated with increased left remodeling risk.High VPA was marginally associated with increased left and right ventricular remodeling risk.Moderate and high LTPA were associated with decreased left ventricular remodeling risk.However,moderate and high OPA/TsPA were associated with increased left ventricular remodeling risk.Part Ⅱ:Association of Leisure-time Physical Activity and Mortality Risk in High Cardiovascular Risk population with and without Left Ventricular HypertrophyBackground:Increased leisure-time physical activity(LTPA)is linked with decreased mortality risk,while also with increased left ventricular mass which may induce left ventricular hypertrophy(LVH).Objective:We investigated whether LVH modifies the association between higher LTPA and mortality risk in populations at high cardiovascular risk.Methods:In a prospective national cohort,we used the left ventricular mass/body surface area(LVM/BSA)method to define LVH.Baseline LTPA was self-reported and divided into:low(<500 metabolic equivalent of task[MET]min/week),moderate(500-1999 MET min/week)and high(≥ 2000 MET-min/week).Analyses of the dose-response relationship between LTPA and left ventricular mass were performed using restricted cubic spline regression.A multivariate adjusted Cox proportional hazards regression analysis was used to estimate hazard ratios(HRs).Results:A total of 163,006 participants(55.3%females;mean[standard deviation]age,62.4[7.4]years)were included.During a median of 4.8 years of follow-up,6586(4.0%)died from all causes and 3,024(1.9%)from cardiovascular causes.Multivariate adjusted Cox proportional hazards regression analyses revealed that moderate and high LTPA were linked with less cardiovascular and all-cause mortality risks than low LTPA in the absence of LVH.In those with LVH,the association of high(0.83,0.69-0.99)or moderate(0.72,0.56-0.91)LTPA with cardiovascular mortality risk persisted.For all-cause mortality risk,this association was only significant in high LTPA(0.73,0.61-0.86),while marginal in moderate LTPA(0.96,0.84-1.08).Overall,the correlation patterns between LTPA and mortality risk appeared distinct between those with LVH and those without LVH;the modification of LVH was not significant regarding mortality risk among the high CVD risk population(all-cause:P interaction=0.074;cardiovascular cause:Pinteraction=0.581),except in females(all-cause:Pinteraction=0.006).Conclusions:The link between higher LTPA and mortality risk was not modified by LVH in high cardiovascular risk populations,expect in females.