Article Impact Level: HIGH Data Quality: STRONG Summary of JAMA Cardiology. https://doi.org/10.1001/jamacardio.2023.1042 Dr. Rachel Lampert et al.
Points
- This prospective cohort study examined the association between vigorous exercise and the risk of ventricular arrhythmias in individuals with hypertrophic cardiomyopathy (HCM).
- The study included 1660 participants aged 8 to 60, with 42% engaging in vigorous-intensity exercise, including competitive participation.
- The primary composite endpoint, encompassing death, resuscitated sudden cardiac arrest, arrhythmic syncope, and appropriate shock from an implantable cardioverter defibrillator, occurred in 4.6% of participants.
- There was no significant difference in the rate of reaching the composite endpoint between individuals engaged in vigorous exercise and those with non-vigorous activity.
- These findings suggest that vigorous exercise does not increase the risk of death or life-threatening arrhythmias in individuals with HCM, providing vital information for patient-clinician discussions regarding exercise participation.
Summary
This investigator-initiated prospective cohort study aimed to determine whether engagement in vigorous exercise is associated with an increased risk of ventricular arrhythmias and/or mortality in individuals with hypertrophic cardiomyopathy (HCM). The study enrolled 1660 participants, with a mean age of 39 years, of which 60% were male. Participants were categorized based on self-reported levels of physical activity: 15% were classified as sedentary, 43% participated in moderate exercise, and 42% engaged in vigorous-intensity exercise, with 37% participating competitively.
The primary composite endpoint, including death, resuscitated sudden cardiac arrest, arrhythmic syncope, and appropriate shock from an implantable cardioverter defibrillator, was reached by 77 individuals (4.6% of the total participants). Among those classified as non-vigorous, 4.6% reached the endpoint, while 4.7% of those engaged in vigorous exercise reached the endpoint. The corresponding rates per 1000 person-years were 15.3 and 15.9, respectively.
In the multivariate Cox regression analysis, individuals engaging in vigorous exercise did not experience a higher rate of events than the non-vigorous group, with an adjusted hazard ratio of 1.01. Furthermore, the upper 95% 1-sided confidence level was 1.48, which remained below the prespecified boundary of 1.5 for noninferiority.
Based on these findings, this cohort study suggests that among individuals with HCM or those who are genotype positive/phenotype negative and receive treatment in experienced centers, engaging in vigorous exercise does not result in a higher rate of death or life-threatening arrhythmias than moderate exercise or a sedentary lifestyle. These data provide valuable insights for informed discussions between patients and expert clinicians regarding exercise participation and management of HCM.
Link to the article: https://jamanetwork.com/journals/jamacardiology/article-abstract/2805064
References Lampert, R., Ackerman, M. J., Marino, B. S., Burg, M., Ainsworth, B., Salberg, L., Tome Esteban, M. T., Ho, C. Y., Abraham, R., Balaji, S., Barth, C., Berul, C. I., Bos, M., Cannom, D., Choudhury, L., Concannon, M., Cooper, R., Czosek, R. J., Dubin, A. M., … Wong, T. (2023). Vigorous exercise in patients with hypertrophic cardiomyopathy. JAMA Cardiology. https://doi.org/10.1001/jamacardio.2023.1042
