Level of physical activity associated with risk of cardiovascular diseases and mortality in patients with type-2 diabetes: report from the Swedish National Diabetes Register

Abstract

Aims

To estimate risks of coronary heart disease (CHD), cardiovascular disease (CVD), and total mortality with low or higher levels of physical activity (PA) assessed with questionnaire, in an observational study of patients with type-2 diabetes from the Swedish National Diabetes Register.

Subjects and methods

A total of 15,462 patients (60 years), were followed for 5 years from baseline in 2004 until 2009, with 760 CVD events and 427 total mortality events based on 54,344 person-years.

Results

Comparing 6963 patients with low baseline PA (never or 1–2 times/week for 30 min) and 8499 patients with higher baseline PA (regular 3 times/week or more), hazard ratios for fatal/nonfatal CHD, fatal/nonfatal CVD, fatal CVD, and total mortality were 1.25 (95% CI 1.05–1.48; p = 0.01), 1.26 (95% CI 1.09–1.45; p = 0.002), 1.69 (95% CI 1.18–2.41; p = 0.004), and 1.48 (95% CI 1.22–1.79; p < 0.001), adjusting for age, sex, diabetes duration, diabetes treatment, and smoking (model 1). Adjusting also for HbA_1c, systolic blood pressure, low- and high-density lipoprotein cholesterol, triglycerides, body mass index, and albuminuria (model 2), HRs were 1.19 (95% CI 1.00–1.42; p = 0.049), 1.18 (95% CI 1.02–1.36; p = 0.04), 1.54 (95% CI 1.07–2.22; p = 0.02), and 1.41 (95% CI 1.16–1.72; p < 0.001), respectively. Corresponding results (model 2), comparing 4166 patients having low PA both baseline and at follow up with all other 11,296 patients were 1.68 (95% CI 1.41–2.01), 1.68 (95% CI 1.45–1.96), 2.12 (95% CI 1.48–3.03), and 2.03 (95% CI 1.66–2.48) (all p < 0.001) and compared to 2797 patients with low baseline PA and higher PA at follow up were 2.51 (95% CI 1.87–3.38), 2.54 (95% CI 1.98–3.27), 3.26 (95% CI 1.74–6.10), and 2.91 (95% CI 2.08–4.07) (all p < 0.001).

Conclusions

This large observational study of patients with type-2 diabetes showed considerably increased risks for CVD and mortality with low PA.

Keywords

Cardiovascular diseases diabetes myocardial infarction physical activity registry

Get full access to this article

View all access options for this article.

References

Erlichman

Kerbey

James

. Physical activity and its impact on health outcomes Paper 1: The impact of physical activity on cardiovascular disease and all-cause mortality: an historical perspective. Obes Rev 2002; 3: 257–271.

Tuomilehto

Silventoinen

. The effects of physical activity and body mass index on cardiovascular, cancer and all-cause mortality among 47 212 middle-aged Finnish men and women. Int J Obes (Lond) 2005; 29: 894–902.

Katzmarzyk

Janssen

Ardern

. Physical inactivity, excess adiposity and premature mortality. Obes Rev 2003; 4: 257–290.

Held

Iqbal

Rosengren

. Physical activity levels, ownership of goods promoting sedentary behaviour and risk of myocardial infarction: results of the INTERHEART study. Eur Heart J 2012; 4: 452–466.

Haapanen

Miilunpalo

Vuori

. Association of leisure time physical activity with the risk of coronary heart disease, hypertension and diabetes in middle-aged men and women. Int J Epidemiol 1997; 26: 739–747.

Salonen

Slater

Tuomilehto

. Leisure time and occupational physical activity: risk of death from ischemic heart disease. Am J Epidemiol 1988; 127: 87–94.

Wei

Gibbons

Kampert

. Low cardiorespiratory fitness and physical inactivity as predictors of mortality in men with type 2 diabetes. Ann Intern Med 2000; 132: 605–611.

Stampfer

Solomon

. Physical activity and risk for cardiovascular events in diabetic women. Ann Intern Med 2001; 134: 96–105.

Batty

Shipley

Marmot

. Physical activity and cause-specific mortality in men with type 2 diabetes/impaired glucose tolerance: evidence from the Whitehall study. Diabet Med 2002; 19: 580–588.

10.

Gregg

Gerzoff

Caspersen

. Relationship of walking to mortality among US adults with diabetes. Arch Intern Med 2003; 163: 1440–1447.

11.

Tanasescu

Leitzmann

Rimm

. Physical activity in relation to cardiovascular disease and total mortality among men with type 2 diabetes. Circulation 2003; 107: 2435–2439.

12.

Eriksson

Barengo

. Occupational, commuting, and leisure-time physical activity in relation to total and cardiovascular mortality among finnish subjects with type 2 diabetes. Circulation 2004; 110: 666–673.

13.

Jousilahti

Tuomilehto

. Physical activity, cardiovascular risk factors, and mortality among finnish adults with diabetes. Diabetes Care 2005; 28: 799–803.

14.

Gudbjörnsdottir

Eliasson

Eeg-Olofsson

. on behalf of the National Diabetes Register (NDR). Additive effects of glycaemia and dyslipidaemia on risk of cardiovascular diseases in type 2 diabetes: an observational study from the Swedish National Diabetes Register. Diabetologia 2011; 54: 2544–2551.

15.

Cederholm

Zethelius

Gudbjörnsdottir

. on behalf of the Swedish National Diabetes Register. Effect of tight control of HbA_1c and blood pressure on cardiovascular diseases in type 2 diabetes: an observational study from the Swedish National Diabetes Register (NDR). Diabetes Res Clin Pract 2009; 86: 74–81.

16.

Zethelius

Eliasson

Cederholm

. A new model for 5-year risk of cardiovascular disease in type 2 diabetes – from the Swedish National Diabetes Register (NDR). Diabetes Res Clin. Pract 2011; 93: 276–284.

17.

Eliasson

Gudbjörnsdottir

Cederholm

. LDL-cholesterol is not the best predictor of CHD risk in type 2 diabetes. Diabetes Care 2011; 34: 2095–2100.

18.

Cederholm

Gudbjörnsdottir Nilsson

. on behalf of the NDR. Systolic blood pressure and risk of cardiovascular diseases in type 2 diabetes: an observational study from the Swedish National Diabetes Register. J Hypertens 2010; 28: 2026–2035.

19.

Eriksson

Zethelius

Eeg-Olofsson

. Blood lipids in 75,048 type 2 diabetic patients: a population-based survey from the Swedish National diabetes register. Eur J Cardiovasc Prev Rehabil 2011; 18: 97–105.

20.

Svensson MK, Cederholm J, Eliasson B, et al. Albuminuria and renal function as predictors of cardiovascular events and mortality in a general population of patients with type 2 diabetes: a nationwide observational study from the Swedish National Diabetes Register. Diab Vasc Dis Res 2013; 10(6): 520--529.

21.

Hoelzel

Weykamp

Jeppsson

. IFCC reference system for measurement of hemoglobin A1c in human blood and the national standardization schemes in the United States, Japan, and Sweden: a method-comparison study. Clin Chem 2004; 50: 166–174.

22.

Merlo

Lindblad

Pessah-Rasmussen

. Comparison of different procedures to identify probable cases of myocardial infarction and stroke in two Swedish prospective cohort studies using local and national routine registers. Eur J Epidemiol 2000; 16: 235–243.

23.

Tunstall-Pedoe

Kuulasmaa

Amouyel

. Myocardial infarction and coronary deaths in the World Health Organization MONICA Project. Registration procedures, event rates, and case-fatality rates in 38 populations from 21 countries in four continents. Circulation 1994; 90: 583–612.

24.

Sigal

Kenny

Wasserman

. Physical activity/exerecise and type 2 diabetes. Diabetes Care 2004; 27: 2518–2539.

25.

American Diabetes Association position statement. Standards of medical care in diabetes 2012. Diabetes Care 2012; 35(Suppl 1): S11–S63.

26.

UK Prospective Diabetes Study Group. Response of fasting plasma glucose to diet therapy in newly presenting type II diabetic patients (UKPDS 7). Metabolism 1990; 39: 905–912.

27.

Leitzmann

Park

Blair

. Physical activity recommendations and decreased risk of mortality. Arch Intern Med 2007; 167: 2453–2460.

28.

Franco

de Laet

Peeters

. Effects of physical activity on life expectancy with cardiovascular disease. Arch Intern Med 2005; 165: 2355–2360.

29.

Jonker

De Laet

Franco

. Physical activity and life expectancy with and without diabetes: life table analysis of the Framingham Heart Study. Diabetes Care 2006; 29: 38–43.

30.

Vepsäläinen

Soinio

Laakso

. Physical activity, high-sensitivity C-reactive protein, and total and cardiovascular disease mortality in type 2 diabetes. Diabetes Care 2011; 34: 1492–1496.

31.

Sluik

Buijsse

Muckelbauer

. Physical activity and mortality in individuals with diabetes mellitus: a prospective study and meta-analysis. Arch Intern Med 2012; 172: 1285–1295.

32.

Talbot

Morrell

Fleg

. Changes in leisure time physical activity and risk of all-cause mortality in men and women: the Baltimore Longitudinal Study of Aging. Prev Med 2007; 45: 169–176.

33.

Byberg

Melhus

Zethelius

. Total mortality after changes in leisure time physical activity in 50 year old men: 35 year follow-up of population based cohort. B J Sports Med 2009; 43: 482–486.

34.

Shephard

. Limits to the measurement of habitual physical activity by questionnaires. Br J Sports Med 2003; 37: 197–206.