Cardiovascular medication, physical activity and mortality: cross-sectional population study with ongoing mortality follow-up

OBJECTIVE: To establish physical activity levels in relation to cardiovascular medication and to examine if physical activity is associated with benefit independently of medication among people with no diagnosis of cardiovascular disease (CVD). DESIGN: Cross-sectional surveys in 1998 and 2003 with continuing mortality follow-up. SETTING: Household-based interviews in England and Scotland. PARTICIPANTS: Population samples of adults aged >or=35 living in households, respondents of the Scottish Health Survey and the Health Survey for England. MAIN OUTCOME MEASURE: Moderate to vigorous physical activity (MVPA) levels and CVD mortality. RESULTS: 15% (n = 3116) of the 20 177 respondents (8791 men) were prescribed at least one cardiovascular drug. Medicated respondents were less likely than those unmedicated to meet the physical activity recommendations (OR = 0.89, 95% CI 0.81 to 0.99, p = 0.028). The mean (SD) follow-up was 6.6 (2.3) years. There were 1509 any-cause deaths and 427 CVD deaths. Increased physical activity was associated with all-cause and CVD mortality among both unmedicated (all-cause mortality hazard ratio (HR) for those with >or=150 min/week of MVPA compared with those who reported no MVPA): HR = 0.58, 95% CI 0.48 to 0.69, p<0.001); CVD mortality: 0.65, 0.46 to 0.91, p = 0.036) and medicated respondents (all-cause death: 0.54, 0.40 to 0.72, p<0.001; CVD death: 0.46 (0.27 to 0.78, p = 0.008). CONCLUSIONS: Although physical activity protects against premature mortality among both medicated and unmedicated adults, cardiovascular medication is linked with lower uptake of health-enhancing physical activity. These results highlight the importance of physical activity in the primary prevention of CVD over and above medication.