Background-We determined whether patients with lower-extremity peripheral arterial disease (PAD) who are more physically active during daily life have lower mortality rates than PAD patients who are less active. Methods and Results-Participants were 460 men and women with PAD (mean age 71.9Ϯ8.4 years) followed up for 57 months (interquartile range 36.6 to 61.9 months). At baseline, participants were interviewed about their physical activity. Vertical accelerometers measured physical activity continuously over 7 days in 225 participants. Analyses were adjusted for age, sex, race, body mass index, hypertension, smoking, comorbidities, total cholesterol, HDL cholesterol, leg symptoms, and ankle-brachial index. At 57-month follow-up, 134 participants (29%) had died, including 75 participants (33%) who wore accelerometers. Higher baseline physical activity levels measured by vertical accelerometer were associated with lower all-cause mortality (P trend ϭ0.003). Relative to PAD participants in the highest quartile of accelerometer-measured physical activity, those in the lowest quartile had higher total mortality (hazard ratio 3.48, 95% confidence interval 1.23 to 9.87, Pϭ0.019). Similar results were observed for the combined outcome of cardiovascular events or cardiovascular mortality (P trend ϭ0.005). Higher numbers of stair flights climbed during 1 week were associated with lower total mortality (P trend ϭ0.035). Conclusions-PAD patients with higher physical activity during daily life have reduced mortality and cardiovascular events compared with PAD patients with the lowest physical activity, independent of confounders. Further study is needed to determine whether interventions that increase physical activity during daily life are associated with improved survival in patients with PAD. (Circulation. 2006;114:242-248.)
Background-Few modifiable behaviors have been identified that are associated with slower rates of functional decline in persons with lower-extremity peripheral arterial disease. We determined whether higher levels of physical activity during daily life are associated with less functional decline in persons with peripheral arterial disease. Methods and Results-The study population included 203 peripheral arterial disease participants who underwent vertical accelerometer-measured physical activity continuously over 7 days and were followed up annually for up to 4 years (mean, 33.6 months). Outcomes were average annual changes in 6-minute walk performance, usual-paced and fast-paced 4-m walking velocity, and the short performance physical battery. Analyses were adjusted for age, sex, race, comorbidities, body mass index, ankle brachial index, smoking, and walking exercise frequency. Higher baseline physical activity levels measured by a vertical accelerometer were associated with significantly less average annual decline in 6-minute walk performance (P for trendϭ0.010), fast-paced 4-m walking velocity (P for trendϭ0.002), and the short performance physical battery (P for trendϭ0.001). Compared with the lowest baseline quartile, those in the highest baseline quartile of physical activity had less annual decline in 6-minute walk performance (Ϫ50.82 versus Ϫ107.0 ft/y; Pϭ0.019), fast-paced 4-m walking speed (Ϫ0.0034 versus Ϫ0.111 m · s Ϫ1 · y
Background Current literature examining the prospective relationship between depression and other measures of negative affect with atrial fibrillation (AF) are limited. We determined the relationships of depression, anger, anxiety, and chronic stress with incident AF in a multiethnic cohort of middle‐ and older‐aged adults. Methods and Results This analysis included 6644 MESA (Multi‐Ethnic Study of Atherosclerosis) study participants who were free of AF at baseline. Depressive symptoms were assessed at baseline and defined as either a 20‐item Center for Epidemiologic Studies Depression Scale score ≥16 or use of antidepressant medications. The Spielberger Trait Anger Scale, Spielberger Trait Anxiety Scale, and Chronic Burden Scale were also administered at baseline to assess anger, anxiety, and chronic stress, respectively. The primary outcome was incident AF , identified by follow‐up study visit ECGs, hospital discharge diagnoses, or Medicare claims data. A total of 875 (13%) incident AF cases were detected over a median follow‐up of nearly 13 years. A Center for Epidemiologic Studies Depression Scale score ≥16 (referent, Center for Epidemiologic Studies Depression Scale score <2) and antidepressant use were associated with a 34% and 36% higher risk of AF , respectively, in separate adjusted Cox proportional hazards analyses (hazard ratio, 1.34; 95% CI 1.04–1.74 for Center for Epidemiologic Studies Depression Scale ≥16; hazard ratio, 1.36; 95% CI , 1.04–1.77 for antidepressant use). No significant associations were observed for anger, anxiety, or chronic stress with development of AF . Conclusions Depressive symptoms are associated with an increased risk of incident AF . Further study into whether improving depressive symptoms reduces AF incidence is important.
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