Author + information
- Received April 18, 2017
- Revision received August 3, 2017
- Accepted August 4, 2017
- Published online September 25, 2017.
- Ralph A.H. Stewart, MDa,∗ (, )
- Claes Held, MD, PhDb,c,
- Nermin Hadziosmanovic, MScc,
- Paul W. Armstrong, MDd,
- Christopher P. Cannon, MDe,
- Christopher B. Granger, MDf,
- Emil Hagström, MD, PhDb,c,
- Judith S. Hochman, MDg,
- Wolfgang Koenig, MDh,i,j,
- Eva Lonn, MDk,
- José C. Nicolau, MDl,
- Philippe Gabriel Steg, MDm,n,o,p,
- Ola Vedin, MDb,c,
- Lars Wallentin, MD, PhDb,c,
- Harvey D. White, MB ChB, DSca,
- on behalf of the STABILITY Investigators
- aGreen Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
- bDepartment of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
- cUppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
- dCanadian Vigour Centre, University of Alberta, Edmonton, Canada
- eCardiovascular Division, Brigham and Women’s Hospital, Boston, Massachusetts
- fDuke Clinical Research Institute, Duke Medicine, Durham, North Carolina
- gDepartment of Medicine, New York University Langone Medical Center, New York, New York
- hDepartment of Internal Medicine II–Cardiology, University of Ulm Medical Center, Ulm, Germany
- iDeutsches Herzzentrum München, Technische Universität München, Munich, Germany
- jDeutsches Zentrum fur Herz-Kreislauf-Forschung (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
- kDepartment of Medicine and Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- lHeart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
- mDépartement Hospitalo-Universitaire FIRE (Fibrosis Inflammation REmodeling), Assistance Publique–Hôpitaux de Paris, Hôpital Bichat, Paris, France
- nParis Diderot University, Sorbonne Paris Cité, Paris, France
- oNational Heart and Lung Institute, Imperial College, Institute of Cardiovascular Medicine and Science, Royal Brompton Hospital, London, United Kingdom
- pFrench Alliance for Cardiovascular Trials, French Clinical Research Infrastructure Network, Institut National de la Santé et de la Recherche Mèdicale U1148, Paris, France
- ↵∗Address for correspondence:
Dr. Ralph A.H. Stewart, Auckland City Hospital, Green Lane Cardiovascular Services, Park Road, Grafton, Auckland 1142, New Zealand.
Background Recommendations for physical activity in patients with stable coronary heart disease (CHD) are based on modest evidence.
Objectives The authors analyzed the association between self-reported exercise and mortality in patients with stable CHD.
Methods A total of 15,486 patients from 39 countries with stable CHD who participated in the STABILITY (Stabilization of Atherosclerotic Plaque by Initiation of Darapladib Therapy) study completed questions at baseline on hours spent each week taking mild, moderate, and vigorous exercise. Associations between the volume of habitual exercise in metabolic equivalents of task hours/week and adverse outcomes during a median follow-up of 3.7 years were evaluated.
Results A graded decrease in mortality occurred with increased habitual exercise that was steeper at lower compared with higher exercise levels. Doubling exercise volume was associated with lower all-cause mortality (unadjusted hazard ratio [HR]: 0.82; 95% confidence interval [CI]: 0.79 to 0.85; adjusting for covariates, HR: 0.90; 95% CI: 0.87 to 0.93). These associations were similar for cardiovascular mortality (unadjusted HR: 0.83; 95% CI: 0.80 to 0.87; adjusted HR: 0.92; 95% CI: 0.88 to 0.96), but myocardial infarction and stroke were not associated with exercise volume after adjusting for covariates. The association between decrease in mortality and greater physical activity was stronger in the subgroup of patients at higher risk estimated by the ABC-CHD (Age, Biomarkers, Clinical–Coronary Heart Disease) risk score (p for interaction = 0.0007).
Conclusions In patients with stable CHD, more physical activity was associated with lower mortality. The largest benefits occurred between sedentary patient groups and between those with the highest mortality risk.
The STABILITY (Stabilization of Atherosclerotic Plaque by Initiation of Darapladib Therapy) trial and the lifestyle substudy were funded by GlaxoSmithKline. The charge for Open Access has been paid by GlaxoSmithKline. Drs. Stewart, Held, Vedin, Hagström, Lonn, Armstrong, Granger, Hochman, Wallentin, and White are STABILITY Study Investigators. Dr. Stewart has received grants and nonfinancial support from GlaxoSmithKline. Dr. Held has received an institutional research grant and Speakers Bureau honoraria from AstraZeneca; and institutional research grants from Bristol-Myers Squibb, Pfizer, Merck & Co., GlaxoSmithKline, and Roche. Mr. Hadziosmanovic has received grants from GlaxoSmithKline. Dr. Armstrong has received grants and personal fees from Merck & Co. and Bayer; grants from Sanofi; and personal fees from AstraZeneca, Axio/Orexigen, Eli Lilly, and Mast Therapeutics. Dr. Cannon has received research grants and consulting fees from Arisaph, AstraZeneca, Bristol-Myers Squibb, Boehringer Ingelheim, GlaxoSmithKline, Merck & Co., Takeda; research grants from Janssen; and consulting fees from Alnylam, Amgen, Boehringer Ingelheim, Eli Lilly, Kowa, Lipimedix, Pfizer, Regeneron, and Sanofi. Dr. Granger has received grants and personal fees from Bristol-Myers Squibb, Pfizer, Bayer, Daiichi-Sankyo, Boehringer Ingelheim, Janssen, AstraZeneca, GlaxoSmithKline, The Medicines Company, and Novartis; grants from Armetheon, Medtronic Foundation, U.S. Food and Drug Administration; and personal fees from Eli Lilly, Gilead, Hoffmann-La Roche, Medtronic Inc., National Institutes of Health, and Verseon. Dr. Hagström has received institutional research grants from GlaxoSmithKline, AstraZeneca, Amgen, Sanofi, and Ariad; has served as an expert committee member for Sanofi and Amgen; has received lecture fees and institutional research grants from Sanofi and Amgen; has received institutional research grants from AstraZeneca and GlaxoSmithKline; and has served as an expert committee member for Ariad and Merck Sharp & Dohme. Dr. Hochman has received travel reimbursement from GlaxoSmithKline; a grant for the ISCHEMIA trial from National Institutes of Health; and support for drug distribution related to the ISCHEMIA trial from AstraZeneca. Dr. Koenig has received lecture and consultancy fees from Novartis, Amgen, and AstraZeneca; lecture fees from Actavis and Berlin-Chemie; consultancy fees from GlaxoSmithKline, The Medicines Company, Pfizer, DalCor, Merck Sharp & Dohme, and Kowa; and research grants from Roche Diagnostics, Abbott, Singulex, and Beckmann. Dr. Lonn has received institutional research grants from GlaxoSmithKline, during the conduct of the study; and institutional research grants from AstraZeneca, Hoffmann-La Roche, Novartis, Eli Lilly, Amgen, and Bayer. Dr. Nicolau has received grant support from Eli Lilly, AstraZeneca, Johnson & Johnson, Bristol-Myers Squibb, Astellas, Sanofi, and Daiichi-Sankyo; has received grant support and personal fees from GlaxoSmithKline, during the conduct of the study; has served as a board member for AstraZeneca, Bayer, and Sanofi; and has received lecture fees from AstraZeneca, Bayer, and Sanofi. Dr. Steg has received personal fees from GlaxoSmithKline, Amarin, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi-Sankyo, Eli Lilly, Merck Sharp & Dohme, Novartis, Pfizer, The Medicines Company, CLS-Behring, and Janssen; grants, institutional research grants, personal fees, honoraria, and nonfinancial support from Sanofi and Servier; honoraria from Amgen and Regeneron; and personal fees, honoraria, and nonfinancial support from AstraZeneca. Dr. Vedin has received institutional research grants from GlaxoSmithKline; and lecture fees from Fresenius and Novartis. Dr. Wallentin has received institutional research grants, consultancy fees, lecture fees, and travel support from Bristol-Myers Squibb, Pfizer, AstraZeneca, GlaxoSmithKline, and Boehringer Ingelheim; institutional research grants from Merck & Co. and Roche; consultancy fees from Abbott; and holds two patents involving GDF-15 proteins. Dr. White has received research grants and personal fees from GlaxoSmithKline; research grants and advisory board member fees from AstraZeneca; advisory board member fees from Acetelion and Sirtex; research grants from Sanofi, Eli Lilly, National Institute of Health, Merck Sharp & Dohme, George Institute, Omthera Pharmaceuticals, Pfizer New Zealand, Intarcia Therapeutics Inc., Elsai Inc., Dal-GenE, and Daiichi-Sankyo Pharma Development. Paul Thompson, MD, served as Guest Editor for this paper.
- Received April 18, 2017.
- Revision received August 3, 2017.
- Accepted August 4, 2017.
- 2017 American College of Cardiology Foundation
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