Cardiovascular disease, 24-h movement behaviors and all-cause mortality: a compositional mediation analysis based on a prospective cohort

We aimed to investigate how 24-hour movement behaviors mediated the association between cardiovascular disease (CVD) and mortality, and to determine 24-hour time-use patterns across different mortality risk strata for CVD patients. The study incorporated 90,858 UK Biobank adults (with a median age of 57 years, 56.2% female and 30.7% CVD patients) who undertook an accelerometer assessment. Cox compositional mediation models were used to determine the mediating effects of 24-hour movement behaviors. The 24-hour time-use patterns at varying risks were determined using risk stratification based on predicted mortality through isotemporal substitution models. During a median follow-up of 13.4 years, 3,047 deaths were recorded. The total indirect effect of CVD on mortality through 24-hour movement behaviors was statistically significant with the mediation proportion being 16.9% for moderate-to-vigorous physical activity (MVPA) and 1.1% for sedentary behavior (SB). The 24-hour time-use pattern of CVD patients with the low mortality risk was predicted to comprise 433, 606, 310, 91 minutes/day on sleep, SB, light-intensity physical activity and MVPA, respectively. Physical activity levels progressively decreased with rising mortality risk. CVD patients at high mortality risk were expected to gain 1.8 years of life by reallocating daily time to match the 24-hour time-use pattern of those at low risk. The association between CVD and mortality is mediated by 24-hour movement behaviors, particularly by MVPA and SB. For CVD patients, tailoring individual physical activity programs to 24-hour time-use patterns at lower risk levels could serve as an effective behavioral intervention strategy for extending lifespan. The top left shows the study timeline and main measurement. The top right shows the analytical workflow. In the bottom demonstrate the main results of the study. a. The mediating effect and effect proportion of 24-hour movement behaviors between CVD and mortality. b. CVD patients were stratified into 4 groups by predictive ranking quartiles and the their 24-hour movement behaviors were described, respectively. The years of life gained by adopting lower-risk patterns at age ≥45 were calculated for CVD patients with high risk. Abbreviations: CVD, cardiovascular disease; LPA, light-intensity physical activity; MACE, major adverse cardiovascular events. MVPA, moderate-to-vigorous intensity physical activity. SLP, sleep; SB, sedentary behavior. • The 24-hour movement behaviors were found to mediate 17.5% of the association between CVD and mortality, with a particular emphasis on MVPA and SB. • The progressive patterns of 24-hour time use under different mortality risk levels were predicted from the standpoint of behavioral substitution. A daily combination of 433, 606, 310, and 91 minutes/day respectively spent on sleep SLP, SB, LPA and MVPA was associated with low mortality risk for CVD patients. • Prolonging lifespan could be achievable by engagement in a preferable daily combination of 24 hours for CVD patients and the 24-hour time-use patterns under different mortality risk levels could serve as progressive behaviors intervention targets in sequential physical activity program.