《柳叶刀》2017年9月21日在线先发
http://thelancet.com/journals/lancet/article/PIIS0140-6736(17)31634-3/fulltext
在17个高收入、中等收入和低收入国家的13万人员中体力活动对死亡率和心血管疾病的影响：PURE研究背景
在高收入国家，体力活动对心血管有保护作用，高收入国家的体力活动主要是娱乐性的，但低收入国家主要是非娱乐性的体力活动，目前尚不知低收入国家的体力活动是否也有保护作用。为此，我们在不同经济水平的国家中，研究了体力活动的不同量、不同类型是否与更低的死亡率、更少的心血管疾病相关。
方法
在这项前瞻性队列研究中，我们招募了17个国家（加拿大、瑞典、阿联酋、阿根廷、巴西、智利、波兰、土耳其、马来西亚、南非、中国、哥伦比亚、伊朗、孟加拉、印度、巴基斯坦和津巴布韦）的参试者。每一个国家内，为反映出地理的多样性，确定出所选择的城市、村镇内及周边区域，在这些社区内，我们邀请年龄在35-70岁且有意在当前居住地至少再呆4年的人员。采用“国际体力活动问卷调查表（IPQA）”评估总体力活动量，之前有心血管疾病的参试者在分析时予以剔除。中位随访6.9个月期间记录死亡和心血管疾病情况。随访期间的主要临床终点为死亡 严重心血管疾病（心血管疾病引起的死亡、新发心肌梗死、脑卒中或心衰），可以是复合终点也可以是各自终点。体力活动对死亡率和心血管疾病的影响用社会人口学因素和考虑到家庭、社区和城市聚集的其它危险因素进行校正。
Background
Physical activity has a protective effect against cardiovascular disease (CVD) in high-income countries, where physical activity is mainly recreational, but it is not known if this is also observed in lower-income countries, where physical activity is mainly non-recreational. We examined whether different amounts and types of physical activity are associated with lower mortality and CVD in countries at different economic levels.
Methods
In this prospective cohort study, we recruited participants from 17 countries (Canada, Sweden, United Arab Emirates, Argentina, Brazil, Chile, Poland, Turkey, Malaysia, South Africa, China, Colombia, Iran, Bangladesh, India, Pakistan, and Zimbabwe). Within each country, urban and rural areas in and around selected cities and towns were identified to reflect the geographical diversity. Within these communities, we invited individuals aged between 35 and 70 years who intended to live at their current address for at least another 4 years. Total physical activity was assessed using the International Physical Activity Questionnaire (IPQA). Participants with pre-existing CVD were excluded from the analyses. Mortality and CVD were recorded during a mean of 6·9 years of follow-up. Primary clinical outcomes during follow-up were mortality plus major CVD (CVD mortality, incident myocardial infarction, stroke, or heart failure), either as a composite or separately. The effects of physical activity on mortality and CVD were adjusted for sociodemographic factors and other risk factors taking into account household, community, and country clustering.
Findings
Between Jan 1, 2003, and Dec 31, 2010, 168 916 participants were enrolled, of whom 141 945 completed the IPAQ. Analyses were limited to the 130 843 participants without pre-existing CVD. Compared with low physical activity (<600 metabolic equivalents [MET] × minutes per week or <150 minutes per week of moderate intensity physical activity), moderate (600–3000 MET × minutes or 150–750 minutes per week) and high physical activity (>3000 MET × minutes or >750 minutes per week) were associated with graded reduction in mortality (hazard ratio 0·80, 95% CI 0·74–0·87 and 0·65, 0·60–0·71; p<0·0001 for trend), and major CVD (0·86, 0·78–0·93; p<0·001 for trend). Higher physical activity was associated with lower risk of CVD and mortality in high-income, middle-income, and low-income countries. The adjusted population attributable fraction for not meeting the physical activity guidelines was 8·0% for mortality and 4·6% for major CVD, and for not meeting high physical activity was 13·0% for mortality and 9·5% for major CVD. Both recreational and non-recreational physical activity were associated with benefits.
Interpretation
Higher recreational and non-recreational physical activity was associated with a lower risk of mortality and CVD events in individuals from low-income, middle-income, and high-income countries. Increasing physical activity is a simple, widely applicable, low cost global strategy that could reduce deaths and CVD in middle age.
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