TRIGGERING OF ACUTE MYOCARDIAL-INFARCTION BY HEAVY PHYSICAL EXERTION - PROTECTION AGAINST TRIGGERING BY REGULAR EXERTION
TRIGGERING OF ACUTE MYOCARDIAL-INFARCTION BY HEAVY PHYSICAL EXERTION - PROTECTION AGAINST TRIGGERING BY REGULAR EXERTION
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DOI：
10.1056/nejm199312023292301
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发表时间：
1993-12-02
影响因子：
158.5
通讯作者：
MULLER, JE
中科院分区：
文献类型：
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作者：
MITTLEMAN, MA;MACLURE, M;MULLER, JE
背景尽管有轶事证据表明，剧烈的体力活动可引发急性心肌梗死的发作，但目前还没有关于剧烈体力活动期间和之后心肌梗死风险、剧烈体力活动与症状发作之间的时间长度（诱导时间）以及是否可以通过定期体力活动来改变风险的对照研究。为了解决这些问题，我们收集了确诊心肌梗死患者在心肌梗死发病前1小时和对照期间的活动数据。对1228例心肌梗死后平均4天进行的访谈提供了他们通常的年度体力活动频率以及心肌梗死发生前26小时内体力活动的时间、类型和强度的数据。我们使用两种基于新病例交叉研究设计的自匹配分析，将观察到的重度运动频率（6个或更多代谢当量）与预期值进行比较。在控制期间，低频率的繁重劳动得到了验证的数据，从人口为基础的对照组的218名受试者。在这些患者中，4.4%的人在心肌梗死发生前一小时内报告了剧烈运动。与不太剧烈的体力活动或不进行体力活动相比，剧烈体力活动后1小时内发生心肌梗死的估计相对危险度为5.9（95%置信区间为4.6 ~ 7.7）。在通常每周锻炼少于1次、1 - 2次、3 - 4次或5次或以上的人群中，相应的相对风险分别为107（95%置信区间，67 - 171）、19.4（9.9 - 38.1）、8.6（3.6 - 20.5）和2.4（1.5 - 3.7）。因此，增加习惯性体力活动水平与逐渐降低的相对风险相关。从剧烈运动到心肌梗死发生的诱导时间小于1小时，症状通常在活动期间开始。剧烈的体力活动会引发急性心肌梗死的发作，特别是习惯久坐的人。提高对重体力活动触发心肌梗死发病机制的理解，以及定期运动预防心肌梗死的方式，将有助于设计新的预防方法。
Background. Despite anecdotal evidence suggesting that heavy physical exertion can trigger the onset of acute myocardial infarction, there have been no controlled studies of the risk of myocardial infarction during and after heavy exertion, the length of time between heavy exertion and the onset of symptoms (induction time), and whether the risk can be modified by regular physical exertion. To address these questions, we collected data from patients with confirmed myocardial infarction on their activities one hour before the onset of myocardial infarction and during control periods.Methods. Interviews with 1228 patients conducted an average of four days after myocardial infarction provided data on their usual annual frequency of physical activity and the time, type, and intensity of physical exertion in the 26 hours before the onset of myocardial infarction. We compared the observed frequency of heavy exertion (6 or more metabolic equivalents) with the expected values using two types of self-matched analyses based on a new case-crossover study design. The low frequency of heavy exertion during the control periods was validated by data from a population-based control group of 218 subjects.Results. Of the patients, 4.4 percent reported heavy exertion within one hour before the onset of myocardial infarction. The estimated relative risk of myocardial infarction in the hour after heavy physical exertion, as compared with less strenuous physical exertion or none, was 5.9 (95 percent confidence interval, 4.6 to 7.7). Among people who usually exercised less than one, one to two, three to four, or five or more times per week, the respective relative risks were 107 (95 percent confidence interval, 67 to 171), 19.4 (9.9 to 38.1), 8.6 (3.6 to 20.5), and 2.4 (1.5 to 3.7). Thus, increasing levels of habitual physical activity were associated with progressively lower relative risks. The induction time from heavy exertion to the onset of myocardial infarction was less than one hour, and symptoms usually began during the activity.Conclusions. Heavy physical exertion can trigger the onset of acute myocardial infarction, particularly in people who are habitually sedentary. Improved understanding of the mechanisms by which heavy physical exertion triggers the onset of myocardial infarction and the manner in which regular exertion protects against it would facilitate the design of new preventive approaches.