# Association of Leisure-Time Physical Activity and Mortality Risk in High Cardiovascular Risk Population with and without Left Ventricular Hypertrophy

## TL;DR

This study finds that higher physical activity is linked to lower mortality risk in high cardiovascular risk populations, even with heart enlargement, though effects differ in women.

## Contribution

The study reveals that left ventricular hypertrophy does not generally modify the mortality benefits of physical activity in high-risk populations, except in women.

## Key findings

- Moderate and high physical activity are associated with lower cardiovascular and all-cause mortality risk in people without left ventricular hypertrophy.
- In those with left ventricular hypertrophy, high physical activity still reduces cardiovascular mortality risk.
- The presence of left ventricular hypertrophy modifies the mortality risk association in women, but not in the overall population.

## Abstract

Increased leisure-time physical activity (LTPA) is linked
with decreased mortality risk, while also with increased left ventricular mass,
which may induce left ventricular hypertrophy (LVH). We investigated whether LVH
modifies the association between higher LTPA and lower mortality risk in
population at high cardiovascular risk.

In a prospective
national cohort, we used the left ventricular mass/body surface area (LVM/BSA)
method to define LVH. Baseline LTPA was self-reported and divided into: low
(<500 metabolic equivalent of task [MET]) min/week), moderate (500–1999 MET
min/week) and high (≥2000 MET-min/week). Analyses of the dose-response
relationship between LTPA and left ventricular mass were performed using
restricted cubic spline regression. A multivariate adjusted Cox proportional
hazards regression analysis was used to estimate hazard ratios (HRs).

A total of 163,006 participants (55.3% females, mean [standard
deviation] age, 62.4 [7.4] years) were included. During a median of 4.8 years of
follow-up, 6586 (4.0%) died from all causes and 3024 (1.9%) from cardiovascular
causes. Multivariate adjusted Cox proportional hazards regression analyses
revealed that moderate and high LTPA were linked with less cardiovascular and
all-cause mortality risk than low LTPA in the absence of LVH. In those with LVH,
the association of high (0.83, 0.69–0.99) or moderate (0.72, 0.56–0.91) LTPA
with cardiovascular mortality risk persisted. For all-cause mortality risk, this
association was only significant in high LTPA (0.73, 0.61–0.86), while marginal
in moderate LTPA (0.96, 0.84 to 1.08). Overall, the correlation patterns between
LTPA and mortality risk appears distinct between those with LVH and those without
LVH; the modification of LVH was not significant regarding mortality risk among
the high cardiovascular risk population (all-cause: p-value for
interaction = 0.074; cardiovascular cause: p-value for interaction =
0.581), except in females regarding all-cause mortality risk (p-value
for interaction = 0.006).

The association between higher
LTPA and lower mortality risk was not modified by LVH in high cardiovascular risk
population. However, the presence of LVH altered this association in females
regarding the all-cause mortality risk.