The association between physical activity and atrial fibrillation applying the Heaviside function in survival analysis: the Multi-Ethnic Study of Atherosclerosis

Abstract

OBJECTIVESAlthough the effect of physical activity (PA) on the incidence of atrial fibrillation (AF) has been studied, contradictory results have been reported. Such discrepancies may reflect the different effects of various types of PA upon AF, as well as gender interactions. Therefore, we aimed to evaluate the associations of PA types (total, moderate/vigorous, and intentional), as well as walking pace, with AF risk in men and women.METHODSUsing the Multi-Ethnic Study of Atherosclerosis Typical Week Physical Activity Survey, 3 PA measures and walking pace were calculated among 6,487 men and women aged 45-84 years. The incidence of AF over approximately 11 years of follow-up was ascertained. The association of each PA measure and walking pace with AF incidence was estimated using multivariable Cox proportional hazard models. An extended Cox model with Heaviside functions (hv) of time was used to estimate the effects of time-varying covariates.RESULTSDuring 11 years of follow-up (49,557 person-years), 242 new AF cases occurred. The incidence rate of AF was 48.83 per 10,000 person-years. The proportional hazard (PH) assumption for total PA among women was not met; hence, we used the hv to calculate the hazard ratio. Total PA in women in the hv2 analysis was negatively associated with AF in all 3 models, although for hv1 no significant association was observed. The PH assumption for walking pace among men was not met, and none of the hv showed a statistically significant association between walking pace and AF in men.CONCLUSIONSThese results suggest that PA is inversely associated with AF in women.

Sex-Specific Exposure–Effect Relationship Between Physical Activity and Incident Atrial Fibrillation in the General Population: A Dose–Response Meta-Analysis of 16 Prospective Studies

“…We excluded 24 studies because they (1) assessed the association of PA with AF in competitive athletes (long-term endurance exercise); (2) were designed as retrospective cohorts or case-control studies; (3) were conference abstracts, reviews, or case reports; or (4) focused on duplicate populations. Finally, we included a total of 16 prospective studies [1 post-hoc analysis of RCTs (20) and 15 prospective cohorts (5)(6)(7)(8)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)] representing a total sample size of 1,449,017 individuals and 39,884 AF cases.…”

“…The duration of follow-up ranged from 3.7 to 22 years. Nine studies (5,7,8,22,25,26,(29)(30)(31) and 11 studies (5,7,8,20,21,23,25,26,(29)(30)(31) reported the association between PA and AF in males and females, respectively. Apart from the study by O'Neal et al (8), the studies relied on self-reported PA collected by questionnaire or interview.…”

Physical Activity and Incidence of Atrial Fibrillation - Systematic Review and Meta-Analysis

“…Four studies were prospective (Bapat et al, 6 Grundvold et al, 7 Mokhayeri et al, 8 Morseth et al, 9 and Mozaffarian et al, 10 ) with mean follow-up periods of 7.7, 35, 11, 20 and 12 years, respectively; a cohort study (Williams et al, 14 ) with mean follow-up period of 6.2 years; a Post-Hoc analysis of a prospective study (Everett et al, 13 ), a crosssectional study (Myrstad et al, 11 ) and an observational study (Qureshi et al, 12 ). In addition to these, one was a Post-Hoc analysis of a Randomized Clinical Trial (Aizer et al, 4 ) with follow-up period of 12 years, and a prospective observational study (Azarbal et al, 5 ) with follow-up period of 11.5 years.…”

“…3 Original Article studies report a J or U curve between the correlation of intensity of physical activity and AF. [4][5][6][7][8][9][10] On the other hand, some studies show a linear correlation between the amount of physical activity and the development of AF. [11][12][13][14] Considering the regular practice of physical activity as a cardiovascular benefit and literature inconsistency about its potential arrhythmogenic effect, the objective of this study was to analyze the effects of physical activity on the incidence of AF.…”

Új felismerések a pitvarfibrilláció genezisében és fenntartásában: az egyénre szabott kezelés lehetőségei

“…Az aerob testedzés során a paraszimpatikus tónus, a baroreceptorok érzékenysége, valamint a szívizomros-tok kolinerg érzékenysége fokozódik, ami együttesen a pitvari refrakteritás csökkenését előidézve PF-t indukál-hat. Újabban az epidemiológiai adatokon kívül [38] humán biokémiai és MRI-vizsgálatokkal is igazolták [39,40], hogy az elhúzódó bal és jobb pitvari fizikai terhelés és a következményes emelkedett pulmonalis nyomás él-sportolókban fokozott pitvari fibrosist is okoz, amely a PF kiváltásában is szerepet játszik. A nem extrém sportterhelés (testedzés) során megnyilvánuló paraszimpatikus tónusfokozódás ugyanakkor a PF szempontjából protektív hatással is bírhat [5,34].…”