Impact of Prolonged Sedentary Behavior on Cardiac Outcomes and Mortality in Acute Coronary Syndrome Patients

这个辅助项目的目的是评估长期久坐的行为作为一种潜在的治疗方法。 急性冠脉综合征(ACS)后的干预目标。超过110万名患者住院治疗 每年仅在美国为ACS提供服务。随着新技术和药物的出现，大多数 因急性冠脉综合征住院的患者存活下来，但他们仍然处于复发心脏事件和 死亡率；强调迫切需要确定可作为干预目标的预后风险因素。 其中一个危险因素可能是久坐不动的行为。有证据表明，久坐不动对健康有害。 行为(而不仅仅是缺乏体力活动)，导致了极大的病理生理变化 增加发病率/死亡率风险。急性冠脉综合征患者特别容易在以下情况下大量坐着 住院；平均每天12-13个小时，许多人每天超过15个小时。这引发了 关于减少久坐行为是否可能代表继发性心脏病的另一个治疗目标的问题 预防独立于体力活动之外的急性冠脉综合征患者。没有现有的指导方针 然而，急性冠脉综合征患者的二级预防提到久坐行为是需要治疗的危险因素。这 遗漏可能是由于缺乏经验证据，因为到目前为止还没有研究评估是否客观地- 测量的久坐行为导致急性冠脉综合征后发病率/死亡风险增加，与心脏无关 疾病严重程度和体力活动。NHLBI资助的“医院后综合症”(PHS)研究提供了一项 评估久坐行为作为急性冠脉综合征幸存者预后风险因素的独特机会。本研究 包括1,000名急性冠脉综合征患者，他们出现在急诊室，并在整个过程中得到跟踪 他们住在医院，以确定住院压力、睡眠、体力活动和/或减肥是否 与30天的再住院有关。在这项辅助研究中，我们建议另外测量久坐时间 应用三轴加速度计对862例PHS患者出院后30天行为的客观研究 既能辨别姿势又能辨别动作。我们还将确定一年内急性冠脉综合征的复发和死亡率 后续行动。最后，我们将评估炎症、促凝血活性和血脂异常的生物标记物。 入院后1个月随访。这些数据将被用来初步评估是否客观测量 在急性冠脉综合征患者中，久坐行为与1年复发事件/死亡的风险有关。 这些数据还将被用于未来的干预措施，以减少急性冠脉综合征幸存者的久坐行为 通过(1)确定减少久坐的策略应采取的活动类型(站立或步行) 靶向，以及(2)确定中间靶点(例如，炎症、促凝血活性、血脂异常)以 评估干预效果。这项研究的结果可能会对二级预防产生重大影响 针对急性冠脉综合征患者的指南，确定是否应该修改这些指南以促进减少 久坐的行为。因此，我们的发现可能会对公共卫生产生强大而持久的影响。

The purpose of this ancillary project is to evaluate prolonged sedentary behavior as a potential therapeutic target for intervention after an acute coronary syndrome (ACS). More than 1.1 million patients are hospitalized annually for ACS in the United States alone. With the advent of new technologies and medications, most patients hospitalized with an ACS survive, however they remain at high risk for recurrent cardiac events and mortality; underscoring a critical need to identify prognostic risk factors that can be targeted for intervention. One such risk factor may be sedentary behavior. Evidence suggests that sedentariness is a “toxic” health behavior (and not merely the absence of physical activity), conferring pathophysiological changes that greatly contribute to morbidity/mortality risk. ACS patients are particularly prone to high volumes of sedentariness after hospitalization; accruing, on average, 12-13 hours/day, with many exceeding 15 hours daily. This raises the question as to whether reducing sedentary behavior may represent another therapeutic target for secondary prevention of ACS patients independent from, and in addition to, physical activity. No existing guidelines for secondary prevention in ACS patients, however, mention sedentary behavior as a risk factor to be treated. This omission may be due to a lack of empirical evidence, as no study to date has assessed whether objectively- measured sedentary behavior incurs increased morbidity/mortality risk post-ACS, independent of cardiac disease severity and physical activity. The NHLBI-funded ‘Post-Hospital Syndrome’ (PHS) study provides a unique opportunity to evaluate sedentary behavior as a prognostic risk factor among ACS survivors. This study comprises a cohort of 1,000 ACS patients who present to the emergency room and are followed throughout their hospital stay to determine whether in-hospital stress, sleep, physical activity, and/or weight loss are associated with 30-day rehospitalization. In this ancillary study, we propose to additionally measure sedentary behavior objectively for 30 days post-discharge among 862 PHS study patients using triaxial accelerometers that can distinguish both posture and movement. We will also ascertain ACS recurrence and mortality at 1-year follow-up. Finally, we will assess biomarkers of inflammation, procoagulant activity, and dyslipidemia in- hospital and at 1-month follow-up. These data will be used to primarily evaluate whether objectively-measured sedentary behavior is associated with risk of 1-year recurrent events/mortality among post-ACS patients. These data will also be used to inform future interventions to reduce sedentary behavior among ACS survivors by (1) determining the type of activity (standing or walking) that sedentary-reduction strategies should be targeting, and (2) identifying an intermediary target (e.g. inflammation, procoagulant activity, dyslipidemia) to assess intervention efficacy. The results of this study could have a major impact on secondary prevention guidelines for ACS patients by determining whether they should be modified to promote reductions in sedentary behavior. Thus, our findings could have a powerful, sustained impact on public health.