The association between physical activity and atrial fibrillation applying the Heaviside function in survival analysis: the Multi-Ethnic Study of Atherosclerosis
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whethOBJECTIVES: Although the effect of physical activity (PA) on the incidence of atrial fibrillation (AF) has been studied, contradictory results have been reported. Such discrepancies may reflect the different effects of various types of PA upon AF, as well as gender interactions. Therefore, we aimed to evaluate the associations of PA types (total, moderate/vigorous, and intentional), as well as walking pace, with AF risk in men and women. METHODS: Using the Multi-Ethnic Study of Atherosclerosis Typical Week Physical Activity Survey, 3 PA measures and walking pace were calculated among 6,487 men and women aged 45-84 years. The incidence of AF over approximately 11 years of follow-up was ascertained. The association of each PA measure and walking pace with AF incidence was estimated using multivariable Cox proportional hazard models. An extended Cox model with Heaviside functions (hv) of time was used to estimate the effects of time-varying covariates. RESULTS: During 11 years of follow-up (49,557 person-years), 242 new AF cases occurred. The incidence rate of AF was 48.83 per 10,000 person-years. The proportional hazard (PH) assumption for total PA among women was not met; hence, we used the hv to calculate the hazard ratio. Total PA in women in the hv2 analysis was negatively associated with AF in all 3 models, although for hv1 no significant association was observed. The PH assumption for walking pace among men was not met, and none of the hv showed a statistically significant association between walking pace and AF in men. CONCLUSIONS: These results suggest that PA is inversely associated with AF in women.
Abstract
whethOBJECTIVES: Although the effect of physical activity (PA) on the incidence of atrial fibrillation (AF) has been studied, contradictory results have been reported. Such discrepancies may reflect the different effects of various types of PA upon AF, as well as gender interactions. Therefore, we aimed to evaluate the associations of PA types (total, moderate/vigorous, and intentional), as well as walking pace, with AF risk in men and women. METHODS: Using the Multi-Ethnic Study of Atherosclerosis Typical Week Physical Activity Survey, 3 PA measures and walking pace were calculated among 6,487 men and women aged 45-84 years. The incidence of AF over approximately 11 years of follow-up was ascertained. The association of each PA measure and walking pace with AF incidence was estimated using multivariable Cox proportional hazard models. An extended Cox model with Heaviside functions (hv) of time was used to estimate the effects of time-varying covariates. RESULTS: During 11 years of follow-up (49,557 person-years), 242 new AF cases occurred. The incidence rate of AF was 48.83 per 10,000 person-years. The proportional hazard (PH) assumption for total PA among women was not met; hence, we used the hv to calculate the hazard ratio. Total PA in women in the hv2 analysis was negatively associated with AF in all 3 models, although for hv1 no significant association was observed. The PH assumption for walking pace among men was not met, and none of the hv showed a statistically significant association between walking pace and AF in men. CONCLUSIONS: These results suggest that PA is inversely associated with AF in women.
참고문헌 (29)
- Benjamin EJ, "Impact of atrial fibrillation on the risk of death: the Framingham Heart Study", Circulation, 98, pp.946~952 (1998)
- Stewart S, "A population-based study of the long-term risks associated with atrial fibrillation: 20-year follow-up of the Renfrew", Paisley study, 2002, pp.113, 359~364
- Wolf PA, "Impact of atrial fibrillation on mortality, stroke, and medical costs", Arch Intern Med, 158, pp.229~234 (1998)
- Rahman F, "Global epidemiology of atrial fibrillation", Nat Rev Cardiol, 11, pp.639~654 (2014)
- Colilla S, "Estimates of current and future incidence and prevalence of atrial fibrillation in the U.S. adult population", Am J Cardiol, 112, pp.1142~1147 (2013)
- Thompson PD, "Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease: a statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity)", Circulation, 107, pp.3109~3116 (2003)
- Mora S, "Physical activity and reduced risk of cardiovascular events: potential mediating mechanisms", Circulation, 116, pp.2110~2118 (2007)
- Aune D, "Physical activity and the risk of type 2 diabetes: a systematic review and dose-response meta-analysis", Eur J Epidemiol, 30, pp.529~542 (2015)
- Soares-Miranda L, "Physical activity and risk of coronary heart disease and stroke in older adults: the Cardiovascular Health Study", Circulation, 133, pp.147~155 (2016)
- Bapat A, "Relation of physical activity and incident atrial fibrillation (from the Multi-Ethnic Study of Atherosclerosis)", Am J Cardiol, 116, pp.883~888 (2015)
- Williams PT, "Reduced incidence of cardiac arrhythmias in walkers and runners", PLoS One, 8, pp.e65302~ (2013)
- Ofman P, "Regular physical activity and risk of atrial fibrillation: a systematic review and meta-analysis", Circ Arrhythm Electrophysiol, 6, pp.252~256 (2013)
- Guasch E, "Atrial fibrillation promotion by endurance exercise: demonstration and mechanistic exploration in an animal model", J Am Coll Cardiol, 62, pp.68~77 (2013)
- Everett BM, "Physical activity and the risk of incident atrial fibrillation in women", Circ Cardiovasc Qual Outcomes, 4, pp.321~327 (2011)
- Mozaffarian D, "Physical activity and incidence of atrial fibrillation in older adults: the cardiovascular health study", Circulation, 118, pp.800~807 (2008)
- Kwok CS, "Physical activity and incidence of atrial fibrillation: a systematic review and meta-analysis", Int J Cardiol, 177, pp.467~476 (2014)
- Nielsen JR, "relationship between physical activity and risk of atrial fibrillation: a systematic review and meta-analysis", J Atr Fibrillation, 5, pp.789~ (2013)
- Bertoni AG, "The association between physical activity and subclinical atherosclerosis: the Multi-Ethnic Study of Atherosclerosis", Am J Epidemiol, 169, pp.444~454 (2009)
- Bild DE, "Multi-Ethnic Study of Atherosclerosis: objectives and design", Am J Epidemiol, 156, pp.871~881 (2002)
- Ainsworth BE, "Moderate physical activity patterns of minority women: the Cross-Cultural Activity Participation Study", J Womens Health Gend Based Med, 8, pp.805~813 (1999)
- LaMonte MJ, "Physical activity, physical fitness, and Framingham 10-year risk score: the cross-cultural activity participation study", J Cardiopulm Rehabil, 21, pp.63~70 (2001)
- Ainsworth BE, "Compendium of physical activities: an update of activity codes and MET intensities", Med Sci Sports Exerc, 32, pp.S498~S504 (2000)
- "Multi-Ethnic Study of Atherosclerosis (MESA)" (2016)[URL]
- Pencina MJ, "Choice of time scale and its effect on significance of predictors in longitudinal studies", Stat Med, 26, pp.1343~1359 (2007)
- Zhu WG, "Sex differences in the association between regular physical activity and incident atrial fibrillation: a meta-analysis of 13 prospective studies", Clin Cardiol, 39, pp.360~367 (2016)
- Wilhelm M, "Gender differences of atrial and ventricular remodeling and autonomic tone in nonelite athletes", Am J Cardiol, 108, pp.1489~1495 (2011)
- Tse HF, "Effect of gender on atrial electrophysiologic changes induced by rapid atrial pacing and elevation of atrial pressure", J Cardiovasc Electrophysiol, 12, pp.986~989 (2001)
- Mont L, "Endurance sport practice as a risk factor for atrial fibrillation and atrial flutter", Europace, 11, pp.11~17 (2009)
- Keadle SK, "Prevalence and trends in physical activity among older adults in the United States: a comparison across three national surveys", Prev Med, 89, pp.37~43 (2016)