Increased physical activity linked to lower risk of developing degenerative valvular heart disease

In a population-based cohort study, higher levels of moderate-to-vigorous physical activity (measured with a wearable device and questionnaire) were associated with lower risks of aortic valve stenosis and related adverse events but not aortic or mitral regurgitation.

This summary is based on the publication of Li Z, Cheng S, Guo B, et al. - Wearable device-measured moderate to vigorous physical activity and risk of degenerative aortic valve stenosis. Eur Heart J. 2024 Jul 2:ehae406 [Online ahead of print]. doi: 10.1093/eurheartj/ehae406

Introduction and methods

Background

Currently, there is no medical therapy that can prevent or slow progression of valvular heart disease (VHD) [1]. Although physical activity has been proven to be effective in preventing ASCVD and related mortality [2,3], its role in preventing degenerative VHD is not fully understood [4-6].

Aim of the study

The authors investigated the dose–response relationship between moderate-to-vigorous physical activity and the risk of degenerative VHD in middle-aged adults.

Methods

In a large-scale, prospective, observational study, 2 sets of data were obtained from UK Biobank participants aged 40–69 years. Objective data on physical activity were collected from 87,248 participants who wore an accelerometer on their dominant wrist from 2013 through 2015 to assess their 7-day physical activity volume (primary cohort). Using the self-reported International Physical Activity Questionnaire – Short Form, subjective physical activity data were collected from 361,681 participants for the period 2006–2010 (secondary cohort).

Outcomes

The primary endpoint was the incidence of degenerative VHD, including aortic valve stenosis (AS), aortic valve regurgitation, and mitral valve regurgitation. The secondary endpoint comprised the incidence of degenerative VHD-related events, defined as the composite outcome of intervention or mortality related to degenerative VHD.

Main results

Risks of aortic valve stenosis and related events

• In the primary cohort (i.e., participants who used a wrist-worn accelerometer), the overall incidence rate of AS was 7.95 per 10,000 person-years (95%CI: 7.31–8.64) and that of AS-related intervention or mortality was 2.86 per 10,000 person-years (95%CI: 2.48–3.29), during a median follow-up time of 8.11 years.
• Higher levels of accelerometer-measured moderate-to-vigorous physical activity were nonlinearly associated with lower risks of developing AS and AS-related events (both nonlinear P<0.001), which leveled off beyond ~300 min/week.
• Across moderate-to-vigorous physical activity quartiles, the incidence rates of AS, adjusted for confounders such as age, sex, smoking status, and diet score, were 11.60 per 10,000 person-years (95%CI: 10.20–13.20) in participants in Q1 (0–74 min/week), 7.82 per 10,000 person-years (95%CI: 6.63–9.23) in Q2 participants (75–167 min/week), 5.74 per 10,000 person-years (95%CI: 4.67–7.08) in Q3 participants (168–301 min/week), and 5.91 per 10,000 person-years (95%CI: 4.73–7.39) in Q4 participants (302–2903 min/week). 
• Compared with the lowest physical activity quartile (Q1), the adjusted incidence rate difference for AS was –3.78 per 10,000 person-years (95%CI: –1.71 to –5.86) in Q2 individuals, –5.85 per 10,000 person-years (95%CI: –3.84 to –7.82) in Q3 individuals, and –5.69 per 10,000 person-years (95%CI: –3.59 to –7.55) in Q4 individuals. The adjusted HRs were 0.71 (95%CI: 0.57–0.87), 0.54 (95%CI: 0.42–0.69), and 0.59 (95%CI: 0.46–0.77), respectively.
• The adjusted incidence rates of AS-related events across moderate-to-vigorous physical activity quartiles (Q1–Q4) were 4.37 per 10,000 person-years (95%CI: 3.52–5.43), 2.81 per 10,000 person-years (95%CI: 2.13–3.71), 1.93 per 10,000 person-years (95%CI: 1.36–2.75), and 2.14 per 10,000 person-years (95%CI: 1.50–3.06).
• Compared with Q1 individuals, the adjusted incidence rate difference for AS-related events was –1.56 per 10,000 person-years (95%CI: –0.25 to –2.80) in Q2 individuals, –2.44 per 10,000 person-years (95%CI: –1.28 to –3.65) in Q3 individuals, and –2.23 per 10,000 person-years (95%CI: –0.97 to –3.56) in Q4 individuals. The adjusted HRs were 0.68 (95%CI: 0.48–0.97), 0.50 (95%CI: 0.33–0.75), and 0.59 (95%CI: 0.39–0.90), respectively.
• Subgroup analysis showed the inverse associations between accelerometer-measured moderate-to-vigorous physical activity volume and risks of AS and AS-related events were consistent in populations at high risk of AS, including the elderly and patients with hypertension, obesity, dyslipidemia, or CKD.
• In the secondary cohort (i.e., participants who filled out a self-reported questionnaire), moderate-to-vigorous physical activity also showed consistent directional associations with AS and AS-related events during a median follow-up time of 13.80 years, albeit with smaller effect sizes. For example, when comparing Q4 individuals (421–2520 min/week) with Q1 individuals (0–60 min/week), the adjusted incidence rate difference for AS was –1.41 per 10,000 person-years (95%CI: –0.67 to –2.14), whereas that for AS-related events was –0.38 per 10,000 person-years (95%CI: –0.04 to –0.88).

Risks of aortic regurgitation, mitral regurgitation, and related events

• The dose–response associations between accelerometer-measured moderate-to-vigorous physical activity volume and the risks of aortic valve regurgitation, mitral valve regurgitation, and related events were less evident.
• Trends in incidence rates suggested a potential decrease in the risks of aortic and mitral valve regurgitation across moderate-to-vigorous physical activity quartiles, but significant group differences were not observed (both nonlinear P>0.05). For example, the adjusted HR for aortic valve regurgitation in Q4 versus Q1 individuals was 0.93 (95%CI: 0.62–1.41), and that for mitral valve regurgitation was 0.99 (95%CI: 0.79–1.25).
• Self-reported moderate-to-vigorous physical activity volume was used to further assess the associations with aortic and mitral valve regurgitation–related events, but this revealed no discernible trends (both P for trend>0.05).

Conclusion

In this prospective, observational, population-based cohort study, nonlinear inverse associations were observed between moderate-to-vigorous physical activity volume (measured with a wrist-worn accelerometers and self-reported questionnaire) and the risks of developing AS and AS-related intervention or mortality. This inverse relation was also observed in high-risk subgroups, such as the elderly and patients with hypertension, obesity, dyslipidemia, or CKD. However, the association between moderate-to-vigorous physical activity volume and the incidence of aortic or mitral valve regurgitation was less evident, “indicating distinct underlying mechanisms for valvular stenosis and regurgitation lesions,” according to the authors.

Find this article online at Eur Heart J.

References

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