Physical Activity and Cardiovascular Disease in African Americans in Atherosclerosis Risk in Communities

Abstract

Purpose Although there is substantial evidence that physical activity reduces a person's risk of cardiovascular disease (CVD), few of these studies have included African Americans. The studies that have included African Americans offer inconclusive evidence on the association and none studied heart failure separately. We used data from the Atherosclerosis Risk in Communities study cohort to examine, in African Americans, the association of physical activity with the incidence of CVD and its major components – stroke, heart failure, and coronary heart disease. Methods Participants aged 45 to 64 years (3,707 African Americans and, for comparison, 10,018 Caucasians) had physical activity assessed via questionnaire in 1987 and were followed for incident CVD (n=1,039) through 2008. Results After adjustment for potential confounders, physical activity was inversely related to CVD, heart failure, and coronary heart disease incidence in both races (p-values for trend <.0001), and with stroke in African Americans. Hazard ratios (95% confidence intervals) for CVD for each higher physical activity category were similar by race: 1.0, 0.65 (0.56, 0.75), and 0.59 (0.49, 0.71) for African Americans and 1.0, 0.74 (0.66, 0.83), and 0.67 (0.59, 0.75) for Caucasians (p-value for interaction = 0.38). Conclusions Our findings reinforce recommendations that regular physical activity is important for CVD risk reduction in African Americans as well as Caucasians and support the idea that some physical activity is better than none.

Effects of Physical Activity and Sedentary Time on the Risk of Heart Failure

“…However, we had limited power to detect significant associations among the black and Asian men. Bell et al, 37 examining physical activity and cardiovascular disease among blacks in the Atherosclerotic Risk In Communities (ARIC) study, reported similar HRs for HF incidence among blacks and whites after 21 years of follow-up. There are several key differences between ARIC and CMHS cohorts.…”

Dose–Response Relationship Between Physical Activity and Risk of Heart Failure

“…Therefore, we used the results of the original studies from multivariable-adjusted models with the most complete adjustment for potential baseline confounders, including the presence of risk factors such as hypertension, diabetes mellitus, and body mass index for primary analysis. One study 19 reported separate HRs for HF risk associated with different PA levels for blacks and whites. As a result, we included data from both the black and white cohorts separately in the pooled analysis.…”

“…[15][16][17] In contrast, the role of PA in reducing risk of HF has not been emphasized in existing guidelines and public health recommendations. 15 Although observational cohort studies have reported an inverse association between higher levels of PA and HF risk, [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] a comprehensive assessment of the quantitative dose-response association between PA and HF risk has not been previously reported. Understanding this relationship is important because recent studies suggest that there may be important differences in the mechanisms through which PA modifies HF risk and CHD risk, 20 and the dose of PA needed to significantly lower HF risk may differ from that currently recommended to reduce CHD risk.…”

Association of Physical Activity or Fitness With Incident Heart Failure

“…All the included physical activity studies divided subjects into 2 or 5 groups on the basis of leisure time, [14][15][16] occupational and leisure-time physical activity, 17,18 vigorous physical activity, 19 cumulative/total physical activity. 20,21 For all the studies included, the extreme groups (ie, maximum versus minimal amount of physical activity) were used for the current analyses.…”

“…25,26 The ascertainment of HF was mostly based on hospital or death records, with only 1 study distinguishing type of HF into HF with reduced ejection fraction versus HF with preserved ejection fraction. 17 The degree of covariate adjustment varied across studies, with 8 studies accounting for intermediate states such as coronary heart disease (CHD) either through adjustment 14,18,21,24 or restriction of analyses to those with nonischemic HF 16,20,23 or exclusion of those with CHD at baseline (either as part of the original study design or a subgroup analysis). 19,24 Study quality varied among the included studies.…”