Exercise capacity and muscle strength and risk of vascular disease and arrhythmia in 1.1 million young Swedish men: cohort study.
Exercise capacity and muscle strength and risk of vascular disease and arrhythmia in 1.1 million young Swedish men: cohort study.
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DOI：
10.1136/bmj.h4543
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发表时间：
2015-09-16
期刊：
影响因子：
--
通讯作者：
Sundström J
中科院分区：
文献类型：
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作者：
Andersen K;Rasmussen F;Held C;Neovius M;Tynelius P;Sundström J
目的探讨青少年后期运动能力和肌力与血管疾病和心律失常的关系。设计队列研究。瑞典的一般人口。参加者：在1972年8月1日至1995年12月31日期间参加强制性兵役的110万男子，平均年龄为18.2岁。参与者被跟踪到2010年12月31日。主要结局：运动能力和肌肉力量与血管疾病和亚组（缺血性心脏病、心力衰竭、中风和心血管性死亡）风险以及心律失常和亚组（心房颤动或扑动、慢速心律失常、室上性心动过速、室性心律失常或心源性猝死）风险的相关性。最大运动能力是通过自行车测力仪测试估计的，肌肉力量是通过手测力仪测量的握力。高运动能力或肌肉力量被认为高于中位数水平。结果在26.3年的中位随访中，共发生血管疾病26 088例，心律失常17 312例。运动能力与血管疾病及其亚群的风险呈负相关。肌肉力量也与血管疾病风险呈负相关，因为肌肉力量越大，心力衰竭和心血管死亡风险越低。运动能力与心律失常风险呈U型相关，与房颤风险直接相关，与慢性心律失常呈U型相关。较高的肌肉力量与较低的心律失常风险相关（特别是较低的慢性心律失常和室性心律失常风险）。与低运动能力和低肌肉力量的组合相比，高运动能力和高肌肉力量的组合与血管事件的风险比为0.67（95%可信区间0.65至0.70）和心律失常的风险比为0.92（0.88至0.97）相关。结论青少年后期的运动能力和肌力与血管疾病和心律失常的长期风险独立或共同相关。较低的血管事件风险和较高的运动能力所带来的健康益处并没有被较高的心律失常风险所抵消。
Objective To investigate the associations of exercise capacity and muscle strength in late adolescence with risk of vascular disease and arrhythmia. Design Cohort study. Setting General population in Sweden. Participants 1.1 million men who participated in mandatory military conscription between 1 August 1972 and 31 December 1995, at a median age of 18.2 years. Participants were followed until 31 December 2010. Main outcomes Associations between exercise capacity and muscle strength with risk of vascular disease and subgroups (ischaemic heart disease, heart failure, stroke, and cardiovascular death) and risk of arrhythmia and subgroups (atrial fibrillation or flutter, bradyarrhythmia, supraventricular tachycardia, and ventricular arrhythmia or sudden cardiac death). Maximum exercise capacity was estimated by the ergometer bicycle test, and muscle strength was measured as handgrip strength by a hand dynamometer. High exercise capacity or muscle strength was deemed as above the median level. Results During a median follow-up of 26.3 years, 26 088 vascular disease events and 17 312 arrhythmia events were recorded. Exercise capacity was inversely associated with risk of vascular disease and its subgroups. Muscle strength was also inversely associated with vascular disease risk, driven by associations of higher muscle strength with lower risk of heart failure and cardiovascular death. Exercise capacity had a U shaped association with risk of arrhythmia, driven by a direct association with risk of atrial fibrillation and a U shaped association with bradyarrhythmia. Higher muscle strength was associated with lower risk of arrhythmia (specifically, lower risk of bradyarrhythmia and ventricular arrhythmia). The combination of high exercise capacity and high muscle strength was associated with a hazard ratio of 0.67 (95% confidence interval 0.65 to 0.70) for vascular events and 0.92 (0.88 to 0.97) for arrhythmia compared with the combination of low exercise capacity and low muscle strength. Conclusions Exercise capacity and muscle strength in late adolescence are independently and jointly associated with long term risk of vascular disease and arrhythmia. The health benefit of lower risk of vascular events with higher exercise capacity was not outweighed by higher risk of arrhythmia.