Key result
High physical activity is linked to ~28% lower mortality, driven primarily by beta-blocker users.
Why the study?
Physical activity and beta-blockers both influence sympathetic activity and vascular function, but whether beta-blocker treatment modifies the association between physical activity and all-cause mortality was unknown.
Does β-blocker treatment modify the association between self-reported physical activity and the risk of all-cause mortality in patients with suspected stable angina pectoris?
Cohort (n=2,284)
Yes
Does β-blocker treatment modify the association between self-reported physical activity and the risk of all-cause mortality in patients with suspected stable angina pectoris?
In patients with suspected stable angina pectoris without prior MI or HFrEF, the mortality benefit of moderate-to-high physical activity was primarily confined to those receiving β-blocker therapy.
Answers are grounded in this paper and cite their sources.
Mortality benefit of physical activity may be confined to β-blocker users in suspected stable angina; leaves open causality and needs prospective confirmation.
Background Physical activity (PA) influences sympathetic stimulation, platelet activation as well as vascular function, and has been associated with improved health outcomes in patients with coronary heart disease. β-blocker therapy reduces sympathetic activity and improves platelet and endothelial function. We investigated if β-blocker treatment modifies the association of self-reported PA with the risk of all-cause mortality. Methods A total of 2284 patients undergoing elective coronary angiography for suspected stable angina pectoris (SAP) were studied. Using Cox modeling, we examined associations between PA (categorized as ‘sedentary/inactive’, ‘low’, ‘moderate’, and ‘high’) and all-cause mortality according to β-blocker therapy. Results During a median follow-up of 10.3 years, 390 patients (17.1%) died. Higher PA was generally associated with a more favorable cardiovascular risk profile. Compared to the patients who were sedentary or inactive, the age and sex adjusted HRs (95% CI) for all-cause mortality were 0.89 (0.66–1.20), 0.73 (0.57–0.95) and 0.72 (0.55–0.95) in the low, moderate and high PA group, respectively. However, and notably, these risk estimates were 0.85 (0.60–1.20), 0.65 (0.47–0.89) and 0.58 (0.41–0.81) in β-blocker treated subjects vs. 1.00 (0.57–1.78), 0.96 (0.61–1.52) and 1.20 (0.74–1.95) in non-treated groups ( P interaction = 0.018). The results were essentially similar in the multivariable adjusted models. Conclusions In patients with suspected SAP, increased PA was associated with reduced mortality risk primarily in patients treated with β-blockers.
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Dhar et al. (2022) conducted a cohort in Suspected stable angina pectoris (n=2,284). High self-reported physical activity (≥4 days/week) vs. lower physical activity levels, stratified by baseline β-blocker therapy vs. Inactive/sedentary physical activity was evaluated on All-cause mortality (HR 0.72, 95% CI 0.55-0.95, p=0.02). High physical activity was associated with reduced all-cause mortality overall (HR 0.72, 95% CI 0.55-0.95), driven by β-blocker users (HR 0.58 vs 1.20 in non-users, P interaction=0.018).
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