Long-term physical activity in leisure time and mortality from coronary heart disease, stroke, respiratory diseases, and cancer. The Copenhagen City Heart Study.

BACKGROUND: The purpose of this study was to describe the associations between different levels of long-term physical activity in leisure time and subsequent causes of deaths. DESIGN: The Copenhagen City Heart Study is a prospective cardiovascular population study of 19 329 men and women aged 20-93 in 1976. Physical activity in leisure time was estimated at the examinations in 1976-78 and 1981-83. This analysis consists of 2136 healthy men and 2758 women aged 20-79 years, with unchanged physical activity at the two examinations, and with all covariates included in the multivariate analyses: smoking, total-cholesterol, high-density lipoprotein-cholesterol, systolic blood pressure, diabetes mellitus, alcohol consumption, body mass index, education, income, and forced expiratory volume in 10.78 (% predicted). RESULTS: Adjusted relative risks (95% confidence interval) for coronary heart disease were, for moderate physical activity 0.71 (0.51, 0.99) and for high 0.56 (0.38, 0.82). For cancer, moderate activity 0.77 (0.61, 0.97) and high activity 0.73 (0.56, 0.95) and for all-cause mortality, moderate 0.78 (0.68, 0.89) and high 0.75 (0.64, 0.87) for both sexes combined. Using Kaplan-Meier plots we calculated gained years of expected lifetime from age 50. Men with high physical activity survived 6.8 years longer, and men with moderate physical activity 4.9 years longer than sedentary men. For women the figures were 6.4 and 5.5 years, respectively. CONCLUSION: Long-term moderate or high physical activity was in both sexes associated with significantly lower mortality from coronary heart disease, cancer and all-causes. The same tendency was found for stroke and respiratory diseases, but the associations did not reach statistical significance.     

Low physical activity as a predictor for total and cardiovascular disease mortality in middle-aged men and women in Finland.

AIMS: To investigate separately for men and women whether moderate or high leisure time physical activity, occupational physical activity, and commuting activity are associated with a reduced cardiovascular disease (CVD) and all-cause mortality, independent of CVD risk factors and other forms of physical activity. METHODS AND RESULTS: Prospective follow-up of 15,853 men and 16,824 women aged 30-59 years living in eastern and south-western Finland (median follow-up time 20 years). CVD and all-cause mortality were lower (9-21%) in men and women (2-17%) who were moderately or highly physically active during leisure time. Moderate and high levels of occupational physical activity decreased CVD and all-cause mortality by 21-27% in both sexes. Women spending daily 15 min or more in walking or cycling to and from work had a reduced CVD and all-cause mortality before adjustment for occupational and leisure time physical activity. Commuting activity was not associated with CVD or all-cause mortality in men. CONCLUSION: Moderate and high levels of leisure time and occupational physical activity are associated with a reduced CVD and all-cause mortality among both sexes. Promoting already moderate levels of leisure time and occupational physical activity are essential to prevent premature CVD and all-cause mortality.     

Intensity versus duration of walking, impact on mortality: the Copenhagen City Heart Study.

BACKGROUND: Current recommendations prescribe that every adult should accumulate 30 min or more of moderate-intensity physical activity in leisure time, preferably all days of the week. To further support these recommendations we examined the impact of walking intensity and walking duration on all-cause mortality. DESIGN: Relative intensity and duration of walking were recorded in 7308 healthy women and men aged 20-93 at the third examination (1991-1994) of the Copenhagen City Heart Study. During an average of 12 years of follow-up 1391 deaths were recorded. RESULTS: For both sexes we found a significant inverse association between walking intensity and risk of death, but only a weak inverse association to walking duration. For women walking with average intensity, the adjusted hazard ratio (HR) of death was 0.75 [95% confidence interval (CI) 0.61-0.92; P<0.01] and walking with fast intensity 0.48 (95% CI 0.35-0.66; P<0.001) compared to women walking with slow intensity. For men the relative risks were 0.54 (95% CI 0.45-0.67; P<0.001) and 0.43 (95% CI 0.32-0.59; P<0.001), respectively. CONCLUSION: Our findings indicate that the relative intensity and not the duration of walking is of most importance in relation to all-cause mortality. Thus our general recommendation to all adults would be that brisk walking is preferable to slow.     

Body mass index, physical inactivity and low level of physical fitness as determinants of all-cause and cardiovascular disease mortality--16 y follow-up of middle-aged and elderly men and women

OBJECTIVE: To investigate the independent associations and the possible interaction of body mass index (BMI), leisure time physical activity (LTPA) and perceived physical fitness and functional capability with the risk of mortality. DESIGN: Prospective 16y follow-up study. SUBJECTS: A regionally representative cohort of 35-63-y-old Finnish men (n= 1,090) and women (n= 1,122). MEASUREMENTS: All-cause, cardiovascular disease (CVD) and coronary heart disease (CHD) mortality were derived from the national census data until the end of September 1996 while the initial levels of BMI, LTPA, physical fitness and function were determined from self-administered questionnaires. RESULTS: After adjustment for age, marital and employment status, perceived health status, smoking and alcohol consumption, the Cox proportional hazards model showed that BMI was not associated with the risk of death among the men or the women. Compared with the most active subjects the men and women with no weekly vigorous activity had relative risks of 1.61 (95% confidence interval, CI, 0.98-2.64) and 4.68 (95% CI, 1.41-15.57), respectively, for CVD mortality, and for the men there was a relative risk of 1.66 (95% CI, 0.92-2.99) for CHD mortality. When compared with the men who perceived their fitness as better than their age-mates, the men with the 'worse' assessment had a relative risk of 3.29 (95% CI, 1.80-6.02) for all-cause mortality and 4.37 (95% CI, 1.80-10.6) for CVD mortality. Men with at least some difficulty in walking a distance of 2 km had a relative risk of 1.62 (95% CI, 1.05-2.50) for all-cause mortality when compared with those who had no functional difficulties. In addition, in the comparison with subjects with no functional difficulties, the men and women who had some difficulty climbing several flights of stairs had relative risks of 1.47 (95% CI, 0.97-2.23) and 2.39 (95% CI, 1.25-4.60) for all-cause mortality, respectively. For CVD mortality the relative risks were 1.85 (95% CI, 1.04-3.30) and 3.38 (1.22-9.41), respectively. CONCLUSIONS: Although BMI did not prove to be an independent risk factor for mortality from CVD, CHD or from all causes combined, perceived physical fitness and functional capability did. An increase in LTPA seems to have a similar beneficial effect on the mortality risk of obese and nonobese men and women, and the effect also seems to be similar for fit and unfit subjects.     

Association of physical activity with all-cause and cardiovascular mortality: a systematic review and meta-analysis.

BACKGROUND: Over the past several decades, numerous large cohort studies have attempted to quantify the protective effect of physical activity on cardiovascular and all-cause mortality. The aim of the authors' review was to provide an up-to-date overview of the study results. METHODS: In a systematic MEDLINE search conducted in May 2007, the authors included cohort studies that assessed the primary preventive impact of physical activity on all-cause and cardiovascular mortality. The authors reported risk reductions on the basis of comparison between the least active and the most active population subgroups, with the least active population subgroup as the reference group. Random-effect models were used for meta-analysis. RESULTS: A total of 33 studies with 883,372 participants were included. Follow-up ranged from 4 years to over 20 years. The majority of studies reported significant risk reductions for physically active participants. Concerning cardiovascular mortality, physical activity was associated with a risk reduction of 35% (95% confidence interval, 30-40%). All-cause mortality was reduced by 33% (95% confidence interval, 28-37%). Studies that used patient questionnaires to assess physical activity reported lower risk reductions than studies that used more objective measures of fitness. CONCLUSIONS: Physical activity is associated with a marked decrease in cardiovascular and all-cause mortality in both men and women, even after adjusting for other relevant risk factors.     

Association of sports activities in leisure time and incident myocardial infarction in middle-aged men and women from the general population: the MONICA/KORA Augsburg cohort study.

BACKGROUND: To examine sex-specific associations between sports activities in leisure time and incident myocardial infarction (MI) in a representative population sample in Germany. DESIGN: Cohort study. METHODS: The study was based on 3501 men and 3475 women (aged 45-74 years) who participated in one of the three MONICA Augsburg surveys between 1984 and 1995 and were followed up until 2002. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated from Cox proportional hazard models. RESULTS: A total of 295 cases of incident MIs among men and 91 among women were registered during a median follow-up period of 8.6 years. In both sexes, moderate and high level of sports activities in leisure time were associated with a reduced risk of incident MI after age and survey adjustment; the HRs of MIs associated with a moderate and high level of sports activities in leisure time were 0.68 (0.49-0.96), and 0.71 (0.50-0.99) for men and 0.42 (0.21-0.84), and 0.18 (0.04-0.74) for women. Further adjustment for other major coronary heart disease risk factors attenuated the HRs: in moderately and highly active men, the HRs were not significant anymore (HRs 0.78 and 0.84, respectively), but the HRs remained significantly reduced in moderately and highly active women (HR 0.49; 95% CI, 0.24-1.00 and HR 0.21; 95% CI, 0.05-0.87, respectively). CONCLUSION: Moderate or high levels of sports activities in leisure time are associated with a significantly reduced risk of MI in women, but not men from the general population.     

Differences in Self‐Reported Physical Activity and Body Mass Index Among Older Hispanic and Non‐Hispanic White Men and Women: Findings from the 2009 California Health Interview Survey

Older Hispanic Americans are a rapidly growing minority group who are disproportionately affected by diabetes mellitus and obesity. Given the importance of physical activity, particularly leisure‐time activity, in the management of diabetes mellitus and obesity, the current study examined ethnic and sex differences in walking for transportation, leisure‐time walking, moderate activity (not including walking), and vigorous activity between Hispanic and non‐Hispanic white (NHW) older adults (age 55 and older) using the 2009 California Health Interview Survey, a population‐based survey representative of California's noninstitutionalized population. The total sample consisted of 21,702 participants (20,148 NHW (7,968 men, 12,180 women) and 1,554 Hispanic (609 men, 945 women)). Multivariable logistic and linear regression analyses were adjusted for sociodemographic characteristics. The findings revealed that Hispanic men and women were significantly less likely to engage in self‐reported leisure‐time walking and vigorous activity than NHW men (adjusted odds ratio (aOR) = 0.71, 95% confidence interval (CI) = 0.51–0.99) and women (aOR = 0.60, 95% CI = 0.42–0.87). Regardless of ethnic group, men were more likely than women to engage in self‐reported walking for transportation (aOR = 0.71, 95% CI = 0.58–0.87), moderate activity (aOR = 0.68, 95% CI = 0.57–0.81), and vigorous activity (aOR = 0.58, 95% CI = 0.50–0.68). All types of self‐reported physical activity were associated with lower body mass index (BMI; P < .001), although significant interactions between sex and leisure time walking (P < .001), moderate activity (P < .001), and vigorous activity (P < .001) indicated that women who engaged in these activities reported the lowest BMIs. The findings highlight the importance of emphasizing walking in efforts to increase moderate and vigorous activity, particularly for older women.     

Physical activity recommendations and decreased risk of mortality

BACKGROUND: Whether national physical activity recommendations are related to mortality benefit is incompletely understood. METHODS: We prospectively examined physical activity guidelines in relation to mortality among 252,925 women and men aged 50 to 71 years in the National Institutes of Health-American Association of Retired Persons (NIH-AARP) Diet and Health Study. Physical activity was assessed using 2 self-administered baseline questionnaires. RESULTS: During 1,265,347 person-years of follow-up, 7,900 participants died. Compared with being inactive, achievement of activity levels that approximate the recommendations for moderate activity (at least 30 minutes on most days of the week) or vigorous exercise (at least 20 minutes 3 times per week) was associated with a 27% (relative risk [RR], 0.73; 95% confidence interval [CI], 0.68-0.78) and 32% (RR, 0.68; 95% CI, 0.64-0.73) decreased mortality risk, respectively. Physical activity reflective of meeting both recommendations was related to substantially decreased mortality risk overall (RR, 0.50; 95% CI, 0.46-0.54) and in subgroups, including smokers (RR, 0.48; 95% CI, 0.44-0.53) and nonsmokers (RR, 0.54; 95% CI, 0.45-0.64), normal weight (RR, 0.45; 95% CI, 0.39-0.52) and overweight or obese individuals (RR, 0.48; 95% CI, 0.44-0.54), and those with 2 h/d (RR, 0.53; 95% CI, 0.44-0.63) and more than 2 h/d of television or video watching (RR, 0.50; 95% CI, 0.45-0.55). Engaging in physical activity at less than recommended levels was also related to reduced mortality risk (RR, 0.81; 95% CI, 0.76-0.86). CONCLUSIONS: Following physical activity guidelines is associated with lower risk of death. Mortality benefit may also be achieved by engaging in less than recommended activity levels.     

Combined effect of blood pressure and physical activity on cardiovascular mortality

BACKGROUND: High blood pressure increases cardiovascular mortality, but whether the effect is counteracted by physical activity is not clear. METHODS: The combined association of blood pressure and physical activity on cardiovascular mortality was assessed in a cohort of 30 597 women and 30 508 men, using standardized blood pressure measurements and information on usual frequency, duration, and intensity of physical exercise. RESULTS: During 16 years of follow-up, 1942 women and 2824 men with no history of cardiovascular disease or diabetes, who had never used blood pressure medication, died from cardiovascular causes. Cardiovascular mortality increased continuously with increasing blood pressure, and, at each blood pressure level, risk was higher in men and women with no physical activity compared with those who reported high physical activity. High activity combined with increasing pressure, however, yielded higher risk than high activity combined with normotensive pressure. Compared with the reference (systolic pressure 120-129 mmHg and high activity), the relative risk of cardiovascular death for systolic pressure of 140-159 mmHg combined with high activity was 1.21 (95% confidence interval, 0.97-1.52), compared with a relative risk of 1.73 (95% confidence interval, 1.37-2.19) in men with no activity. For women, the corresponding relative risks were 1.47 (95% confidence interval, 1.04-2.09) in the high activity group and 1.93 (95% confidence interval, 1.39-2.69) for no activity. The combined results for diastolic pressure and physical activity displayed similar patterns. CONCLUSIONS: The results support the hypothesis that cardiovascular health of individuals with moderate hypertension will benefit from regular physical exercise.     

A comparison of body mass index, waist-hip ratio and waist circumference as predictors of all-cause mortality among the elderly: the Rotterdam study.

OBJECTIVE: To compare body mass index (BMI), waist-hip ratio (WHR) and waist circumference as predictors of all-cause mortality among the elderly. DESIGN: Population-based cohort study; mean follow-up was 5.4 y. SETTING: The Rotterdam Study. PARTICIPANTS: A total of 6296 men and women; baseline age 55-102 y. MEASUREMENTS: Sex-specific all-cause mortality was compared between quintiles of BMI, WHR and waist circumference and between predefined categories of BMI and waist circumference, stratified for smoking category. RESULTS: High quintiles of waist circumference, but not high quintiles of BMI and WHR were related to increased mortality among never smoking men, without reaching statistical significance. Only the highest category of BMI (BMI>30 kg/m2) among never smoking men was related to increased mortality, compared to normal BMI (hazard ratio 2.6 (95% confidence interval: 1.3-5.3)). Waist circumference between 94 and 102 cm and waist circumference 102 cm and larger were related to increased mortality, compared to normal waist circumference (hazard ratios 1.7 (95% confidence interval 1.1-2.8) and 1.6 (95% confidence interval 1.0-2.8), respectively). The proportion of mortality attributable to large waist circumference among never smoking men was three-fold the proportion attributable to high BMI. Among never smoking women and ex- and current smokers, categories of large body fatness did not predict increased mortality. CONCLUSION: Among never smoking elderly men waist circumference may have more potential for detecting overweight than the BMI.     

Ethnic differences in cardiovascular and all-cause mortality in Birmingham, England: the Birmingham Factory Screening Project

OBJECTIVES: To compare cardiovascular and all-cause mortality, among white Europeans, African-Caribbeans and South-Asians, in relation to baseline demographic characteristics and blood pressure variables. DESIGN: Observational follow-up study. SETTING: Community settings in Birmingham, UK. PARTICIPANTS: Two thousand and eighty-nine white European and 340 African-Caribbean men and women, and 195 South-Asian men whose survival status on 31 December 2003 was known. INTERVENTIONS: Follow-up for assessment of all-cause and cardiovascular mortality over a mean (SD) 20.3 (4.2) years. MAIN OUTCOME MEASURES: All-cause and cardiovascular mortality. RESULTS: There were no significant ethnic differences in all-cause or cardiovascular mortality for men [adjusted hazard ratio (HR) = 1.02; 95% confidence interval (CI), 0.80-1.28 and HR = 1.33; 95% CI, 0.99-1.79, respectively] or women (adjusted HR = 0.61; 95% CI, 0.29-1.32 and HR = 1.19; 95% CI, 0.41-3.45, respectively) in either univariate or multivariate analyses. The only independent predictors of both all-cause and cardiovascular mortality were age, sex, smoking and mean systolic blood pressure or hypertension. CONCLUSIONS: It appears that ethnicity per se is not an independent risk factor for all-cause and cardiovascular mortality between white Europeans and African-Caribbeans in the present study. The data concerning ethnic differences in all-cause and cardiovascular mortality for South-Asians is limited, given that significantly fewer South-Asian men could be traced by the Office for National Statistics (ONS), hence we do not know their survival status, and the total lack of data on South-Asian women.     

Obesity,Abdominal Obesity,Physical Activity,and Caloric Intake in US Adults: 1988 to 2010

Background

Obesity and abdominal obesity are associated independently with morbidity and mortality. Physical activity attenuates these risks. We examined trends in obesity, abdominal obesity, physical activity, and caloric intake in US adults from 1988 to 2010.

Methods

Univariate and multivariate analyses were performed using National Health and Nutrition Examination Survey data.

Results

Average body mass index (BMI) increased by 0.37% (95% confidence interval [CI], 0.30-0.44) per year in both women and men. Average waist circumference increased by 0.37% (95% CI, 0.30-0.43) and 0.27% (95% CI, 0.22-0.32) per year in women and men, respectively. The prevalence of obesity and abdominal obesity increased substantially, as did the prevalence of abdominal obesity among overweight adults. Younger women experienced the greatest increases. The proportion of adults who reported no leisure-time physical activity increased from 19.1% (95% CI, 17.3-21.0) to 51.7% (95% CI, 48.9-54.5) in women, and from 11.4% (95% CI, 10.0-12.8) to 43.5% (95% CI, 40.7-46.3) in men. Average daily caloric intake did not change significantly. BMI and waist circumference trends were associated with physical activity level but not caloric intake. The associated changes in adjusted BMIs were 8.3% (95% CI, 6.9-9.6) higher among women and 1.7% (95% CI, 0.68-2.8) higher among men with no leisure-time physical activity compared with those with an ideal level of leisure-time physical activity.

Conclusions

Our analyses highlight important dimensions of the public health problem of obesity, including trends in younger women and in abdominal obesity, and lend support to the emphasis placed on physical activity by the Institute of Medicine.     

Relations between QRS|T angle, cardiac risk factors, and mortality in the third National Health and Nutrition Examination Survey (NHANES III)

On the surface electrocardiogram, an abnormally wide QRS|T angle reflects changes in the regional action potential duration profiles and in the direction of the repolarization sequence, which is thought to increase the risk of ventricular arrhythmia. We investigated the relation between an abnormal QRS|T angle and mortality in a nationally representative sample of subjects without clinically evident heart disease. We studied 7,052 participants ≥40 years old in the third National Health and Nutrition Examination Survey with 12-lead electrocardiograms. Those with self-reported or electrocardiographic evidence of a previous myocardial infarction, QRS duration of ≥120 ms, or history of heart failure were excluded. Borderline and abnormal spatial QRS|T angles were defined according to gender-specific 75th and 95th percentiles of frequency distributions. All-cause (1,093 women and 1,191 men) and cardiovascular (462 women and 455 men) mortality during the 14-year period was assessed through linkage with the National Death Index. On multivariate analyses, an abnormal spatial QRS|T angle was associated with an increased hazard ratio (HR) for cardiovascular mortality in women (HR 1.82, 95% confidence interval 1.05 to 3.14) and men (HR 2.21, 95% confidence interval 1.32 to 3.68). Also, the multivariate adjusted HR for all-cause mortality associated with an abnormal QRS|T angle was 1.30 (95% confidence interval 0.95 to 1.78) for women and 1.87 (95% confidence interval 1.29 to 2.7) for men. A borderline QRS|T angle was not associated with an increased risk of all-cause or cardiovascular mortality. In conclusion, an abnormal QRS|T angle, as measured on a 12-lead electrocardiogram, was associated with an increased risk of cardiovascular and all-cause mortality in this population-based sample without known heart disease.     

Usefulness of self-reported leisure-time physical activity to predict long-term survival in patients with coronary heart disease

Self-reported leisure-time physical activity level correlates well with both cardiovascular (CV) and non-CV mortality in subjects without coronary heart disease (CHD). The impact of leisure-time physical activity on long-term outcomes has not been well studied in patients with preexisting CHD, who are often physically limited because of symptoms, medications, and co-morbid conditions. The aim was to determine the long-term prognostic value of self-reported leisure-time physical activity in a large CHD cohort. Leisure-time physical activity was evaluated using a self-administered questionnaire and categorized using a 4-level scale (sedentary, mild, moderate, and strenuous) in 14,021 of 24,958 subjects from the Coronary Artery Surgery Study Registry with suspected or proven CHD who underwent cardiac catheterization from 1974 to 1979. Median long-term follow-up was 14.7 years (interquartile range 9.8 to 16.2). Clinical outcomes were evaluated according to physical activity level and adjusted for potential confounders. Long-term all-cause and CV mortality progressively increased from most to least active subjects, with sedentary patients showing a 1.6-fold increase in mortality for both these outcomes (hazard ratio [HR] 1.63, 95% confidence interval [CI] 1.34 to 1.97, p <0.0001 for all-cause mortality). Similar trends were noted for men and women and in adjusted models, although HRs were attenuated after adjusting for age, gender, smoking, hypertension, diabetes mellitus, total cholesterol, body mass index, and ejection fraction (adjusted HR 1.23, 95% CI 1.01 to 1.49, p = 0.03 for all-cause mortality; adjusted HR 1.25, 95% CI 0.99 to 1.57, p = 0.05 for CV mortality). In conclusion, leisure-time physical activity independently predicted long-term survival in men and women with chronic stable CHD.     

Adiposity and physical activity as predictors of cardiovascular mortality.

OBJECTIVE: To investigate whether cardiovascular mortality related to obesity could be modified by physical activity. DESIGN: Mortality follow-up. SETTING: Population study. PARTICIPANTS: Participants in a health survey: 34 868 women and 32 872 men free from known cardiovascular disease or diabetes at baseline. MAIN OUTCOME MEASURES: Total cardiovascular mortality. MAIN RESULTS: During 16 years of follow-up, 3026 women and 3526 men had died from cardiovascular causes. In middle age, obesity [body mass index (BMI) of 30 or higher] was associated with increased risk of cardiovascular death, but the association weakened with age. After 70, there was no association between BMI and cardiovascular death. At all ages, a lower level of physical activity was associated with a higher cardiovascular mortality. In women with high physical activity, indicated by at least 30 min of moderate to vigorous activity more than once a week, cardiovascular mortality was only slightly higher in the obese compared to lean women (adjusted relative risk, 1.27; 95% confidence interval, 0.80-2.00). In men with high physical activity, cardiovascular mortality was, however, significantly higher among the obese (relative risk, 1.62; 95% confidence interval, 1.09-2.40). In both genders cardiovascular mortality was substantially higher in obese people who reported no regular physical activity compared to obese people with a high level of physical activity. CONCLUSION: In obese women, being highly active may, to a large extent, compensate for the risk-increasing effect of being obese, whereas in obese men who engage in a high level of physical activity, the risk of cardiovascular death may be higher than in lean and equally active men.     

Explaining the sex difference in coronary heart disease mortality among patients with type 2 diabetes mellitus: a meta-analysis

BACKGROUND: Most studies suggest that diabetes is a stronger coronary heart disease (CHD) risk factor for women than men, but few have adjusted their results for classic CHD risk factors: age, hypertension, total cholesterol level, and smoking. OBJECTIVE: To establish an accurate estimate of the odds ratio for fatal and nonfatal CHD due to diabetes in both men and women. METHODS: We compared the summary odds ratio for CHD mortality and the absolute rates of CHD mortality in men and women with diabetes. We searched the MEDLINE and Cochrane Collaboration databases and bibliographies of relevant articles and consulted experts. Studies that included a nondiabetic control group and provided sex-specific adjusted results for CHD mortality, nonfatal myocardial infarction, and cardiovascular or all-cause mortality were included. Of 4578 articles identified, 232 contained primary data, and 182 were excluded. Two reviewers recorded data on study characteristics, quality, and outcomes from 50 studies. RESULTS: Sixteen studies met all inclusion criteria. In unadjusted and age-adjusted analyses, odds of CHD death were higher in women than men with diabetes. From 8 prospective studies, the multivariate-adjusted summary odds ratio for CHD mortality due to diabetes was 2.3 (95% confidence interval, 1.9-2.8) for men and 2.9 (95% confidence interval, 2.2-3.8) for women. There were no significant sex differences in the adjusted risk associated with diabetes for CHD mortality, nonfatal myocardial infarction, and cardiovascular or all-cause mortality. Absolute CHD death rates were higher for diabetic men than women in every age strata except the very oldest. CONCLUSIONS: The excess relative risk of CHD mortality in women vs men with diabetes was absent after adjusting for classic CHD risk factors, but men had more CHD deaths attributable to diabetes than women.     

Risk factors for total hip replacement due to primary osteoarthritis: a cohort study in 50,034 persons

OBJECTIVE: To identify prospectively the possible risk factors for total hip replacement (THR) due to primary osteoarthritis in a large cohort. METHODS: Data from a cardiovascular screening were matched with 9 years of national data on THR. Mean age at the start of followup was 54.9 years, and the 50,034 participants were followed up for an average of 9 years. During followup, 672 persons had a first THR due to primary osteoarthritis. RESULTS: We found dose-response associations between body mass index (BMI), body weight, and the level of physical activity at work and THR for primary osteoarthritis. The highest versus the lowest quarter of BMI had a relative risk of 2.0 (95% confidence interval [95% CI] 1.4-2.9) among men and 3.0 (95% CI 2.1-4.1) among women. The highest versus the lowest quarter of body weight had a relative risk of 2.1 (95% CI 1.4-3.2) among men and 3.4 (95% CI 2.4-4.9) among women. Intensive versus sedentary physical activity at work had a relative risk of 2.1 (95% CI 1.5-3.0) among men and 2.1 (95% CI 1.3-3.3) among women. No association was found between physical activity in leisure and THR for primary osteoarthritis. CONCLUSION: Intensive physical activity at work and a high BMI each contribute significantly to the overall risk of undergoing THR due to primary osteoarthritis. Lowering the exposure to these risk factors may substantially reduce the need for hip replacement.     

Leisure time physical activity and coronary heart disease death. The US Railroad Study

Seventeen to 20 years of mortality follow-up were used to study the relation of leisure time physical activity (LTPA) to coronary heart disease mortality and to all-cause mortality in white male US railroad workers (n = 3,043). This cohort was initially examined from 1957 to 1960, reexamined from 1962 to 1964, and followed until 1977 or death. LTPA was ascertained by a precursor of the Minnesota Leisure Time Physical Activity Questionnaire. The risk estimate for coronary heart disease death, after adjusting for age, was 1.39 for sedentary men who expended 40 kcal/wk in LTPA compared with very active men who expended 3,632 kcal/wk. This relation was attenuated by adjusting for other coronary heart disease risk factors, but it remained independent and significant. Caloric expenditure in light and moderate activity, as well as that performed in any intense activity, showed independent relations to cardiovascular death and all-cause mortality. Associations were slightly stronger in occupationally sedentary men. These results support the hypothesis that physical activity protects against death from coronary heart disease and all-cause mortality.     

The relationship between resting heart rate and all-cause, cardiovascular and cancer mortality

AIMS: The association between resting heart rate and changes in heartrate with all-cause, cardiovascular and cancer mortality wasstudied among 1827 men and 2929 women, aged 40–80 years,followed for 12 years. METHODS AND RESULTS: After adjustment for initial age, serum cholesterol, body massindex, systolic blood pressure, smoking and diabetes, the all-causemortality hazard ratio was 1·7 (95% confidence interval1·4–2·2) for heart rate increments of 20beats.min^–1 for men and 1·4 (confidence interval1·1–1·8) for women. For cardiovascular mortality,the risk estimates were 1·7 (confidence interval 1·2–2·6)for men and 1·3 (confidence interval 0·9–2·0)for women. We observed no significant association between heartrate and cancer mortality. For women, stronger predictive informationfor all-cause mortality was provided if changes in heart ratewere evident at the 2-year review. CONCLUSION: The resting heart rate is a predictor of mortality, independentof major cardiovascular risk factors.     

Usefulness of cardiorespiratory fitness as a predictor of all-cause and cardiovascular disease mortality in men with systemic hypertension

There is an inverse gradient of mortality across levels of cardiorespiratory fitness in healthy adults; however, the association of fitness to mortality in persons with comorbidities such as hypertension is not fully understood. This study quantifies the relation of cardiorespiratory fitness to all-cause mortality and cardiovascular disease (CVD) mortality in hypertensive men. In this observational cohort study, we calculated death rates for low, moderate, and high fitness categories in normotensive (n = 15,726) and hypertensive (n = 3,184) men, and in men without a history of hypertension but with elevated blood pressure (BP) (systolic BP > or = 140 or diastolic BP > or = 90 mm Hg) at baseline (n = 3,257). The participants were 22,167 men (average age 42.6 +/- 9.2 years [mean +/- SD]) who underwent a medical examination that included a maximal exercise test during 1970 to 1993, with mortality follow-up to December 31, 1994. We identified 628 deaths (188 from CVD) during 224,173 man-years of observation. There was an inverse linear trend across fitness groups for all-cause and CVD mortality. The relative risk (95% confidence interval [CI]), using the low fitness group as reference, for all-cause mortality in hypertensive men was 0.45 (95% CI 0.31 to 0.65) and 0.42 (95% CI 0.27 to 0.66) for moderate and high fitness groups, respectively, and in men with elevated BP, 0.49 (95% CI 0.34 to 0.70) and 0.44 (95% CI 0.29 to 0.68) for moderate and high fitness groups, respectively. The pattern of results was similar for CVD mortality. There was an inverse linear relation between fitness and death rate for all-cause mortality in both the uncontrolled and controlled hypertensive groups. This study provides evidence that moderate to high levels of cardiorespiratory fitness provide protection against all-cause and CVD mortality in hypertensive men and men without a history of hypertension but with elevated BP at examination.