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Context: Exercise is associated with a lower risk of cardiovascular events but may transiently increase the risk of ventricular arrhythmias. Its short-term and long-term associations with risk of sudden cardiac death among women are unclear. Objectives: To compare the risk of sudden cardiac death in women during mo derate to vigorous exertion with the risk of sudden cardiac death during lighter or no exertion; and to assess the long-term association between moderate to vi gorous exercise and sudden cardiac death. Design, Setting, and Participants: Pro spective, nested case-crossover study of 288 cases of sudden cardiac death with in the Nurses’Health Study(1980-2004); and a prospective cohort analysis of 69 693 participants without prior cardiovascular disease followed up from 1986-20 04. Main Outcome Measure: Risk of sudden cardiac death associated with moderate to vigorous exertion. Results: The absolute risk of sudden cardiac death associa ted with moderate to vigorous exertion was exceedingly low at 1 per 36.5 million hours of exertion. In case-crossover analyses, the risk of sudden cardiac death was transiently elevated during moderate to vigorous exertion(relative risk[RR ], 2.38; 95%confidence interval[CI], 1.23-4.60; P=.01) compared with the risk during lesser or no exertion. Habitual moderate to vigorous exertion modified th is transient risk(P=.005 for interaction) and the risk was no longer significant ly elevated among those who exercised 2 or more hours per week. In the cohort an alyses, an increasing amount of moderate to vigorous exercise was associated with a lower long-term risk of sudden cardiac death in ageadjusted and multivariable models that excluded biological intermediates(P=.006 for trend). This relatio nship was attenuated when biological intermediates were included(P=.06 for trend ); however, the reduction in risk remained significant among women who exercised 4 or more hours per week(adjusted RR, 0.41; 95%CI, 0.20-0.83; P=.01) compared with women who did not exercise. Conclusions: These prospective data suggest th at sudden cardiac death during exertion is an extremely rare event in women. Reg ular exercise may significantly minimize this small transient risk and may lower the overall long-term risk of sudden cardiac death.
Context: Exercise is associated with a lower risk of cardiovascular events but may transiently increase the risk of ventricular arrhythmias. Its short-term and long-term associations with risk of sudden cardiac death among women are unclear. Objectives: To compare the risk of sudden sudden cardiac death in women during mo derate to vigorous exertion with the risk of sudden cardiac death during lighter or no exertion; and to assess the long-term association between moderate to vi gorous exercise and sudden cardiac death. Design, Setting, and Participants: Pro spective, nested case-crossover study of 288 cases of sudden cardiac death with in the Nurses’Health Study (1980-2004); and a prospective cohort analysis of 69 693 participants without prior cardiovascular disease followed from 1986-20 04. Main Outcome Measure: Risk of sudden cardiac death associated with moderate to vigorous exertion. Results: The absolute risk of sudden cardiac death associated with ted with moderate to vigorous exertion was exceedingly low at 1 per 36.5 million hours of exertion. In case of crossover analyzes, the risk of sudden cardiac death was transiently elevated during moderate to vigorous exertion (relative risk [RR], 2.38; 95% confidence interval [CI] 4.60; P = .01) compared with the risk during lesser or no exertion. Habitual moderate to vigorous exertion modified th is transient risk (P = .005 for interaction) and the risk was no longer significantly elevated elevated those those who exercised 2 or In the cohort an alyses, an increasing amount of moderate to vigorous exercise was associated with a lower long-term risk of sudden cardiac death in ageadjusted and multivariable models that excluded biological intermediates (P = .006 for trend). This relatio nship was attenuated when biological intermediates were included (P = .06 for trend); however, the reduction in risk was significant among women who exercised 4 or more hours per week (adjusted RR, 0.41; 95% CI, 0.20-0.83 ; P = .01) compared with women who did not exercise. Conclusions: These prospective data suggest that at sudden cardiac death during exertion is an extremely rare event in women. death.