Physical Activity and Risk for Cardiovascular Events in Diabetic Women
- Frank B. Hu, MD;
- Meir J. Stampfer, MD;
- Caren Solomon, MD;
- Simin Liu, MD;
- Graham A. Colditz, MD;
- Frank E. Speizer, MD;
- Walter C. Willett, MD; and
- JoAnn E. Manson, MD
- From Harvard School of Public Health, Harvard Medical School, and Brigham and Women's Hospital, Boston, Massachusetts.
Abstract
Background: Increased physical activity has been associated with reduced risk for cardiovascular disease in the general population, but data are limited on its role among persons with type 2 diabetes mellitus.
Objective: To determine whether physical activity decreases risk for cardiovascular disease among diabetic women.
Design: Prospective cohort study.
Setting: The Nurses' Health Study.
Patients: 5125 female nurses with diabetes.
Measurements: Physical activity was first assessed in 1980 and was updated in 1982, 1986, 1988, and 1992 through validated questionnaires. Average hours of moderate or vigorous exercise and a metabolic equivalent of task (MET) score were computed.
Results: During 14 years of follow-up (31 432 person-years), 323 new cases of cardiovascular disease were documented (225 cases of coronary heart disease and 98 cases of stroke). The age-adjusted relative risks according to average hours of moderate or vigorous activity per week (<1, 1 to 1.9, 2 to 3.9, 4 to 6.9, ≥ 7) were 1.0, 0.93 (95% CI, 0.69 to 1.26), 0.82 (CI, 0.61 to 1.10), 0.54 (CI, 0.39 to 0.76), and 0.52 (CI, 0.25 to 1.09) (P < 0.001 for trend). These figures did not change materially after adjustment for smoking, body mass index, and other cardiovascular risk factors (1.0, 1.02, 0.87, 0.61, and 0.55, respectively; P = 0.001 for trend). In separate analyses, levels of physical activity were inversely associated with coronary heart disease and ischemic stroke. Among women who did not exercise vigorously, the multivariate relative risks for cardiovascular disease across quartiles of MET score for walking were 1.0, 0.85, 0.63, and 0.56 (P = 0.03 for trend). Faster usual walking pace was independently associated with lower risk.
Conclusion: Among diabetic women, increased physical activity, including regular walking, is associated with substantially reduced risk for cardiovascular events.
Article and Author Information
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Acknowledgments: The authors thank the participants in the Nurses' Health Study for their continuing outstanding level of cooperation and Al Wing, Gary Chase, Karen Corsano, Lisa Dunn, Barbara Egan, Lori Ward, Erin Boyd, and Jill Arnold for their unfailing help.
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Grant Support: By the National Institutes of Health (DK 36798 and CA40356). Dr. Hu's work is supported by an American Diabetes Association Research Award. Dr. Caren Solomon is supported by an American Heart Association Clinical Scientist Award.
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Requests for Single Reprints: Frank B. Hu, MD, Department of Nutrition, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115; e-mail, Frank.hu{at}channing.harvard.edu.
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Current Author Addresses: Drs. Hu and Willett: Department of Nutrition, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115.
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Drs. Stampfer, Colditz, and Speizer: Channing Laboratory, Brigham and Women's Hospital, 181 Longwood Avenue, Boston, MA 02115.
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Dr. Solomon: Division of General Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115.
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Drs. Liu and Manson: Division of Preventive Medicine, Brigham and Women's Hospital, 900 Commonwealth Avenue East, Boston, MA 02215.
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Author Contributions: Conception and design: F.B. Hu, M.J. Stampfer, G.A. Colditz, F.E. Speizer, W.C. Willett, J.E. Manson.
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Analysis and interpretation of the data: F.B. Hu, M.J. Stampfer, C. Solomon, S. Liu, G.A. Colditz, W.C. Willett, J.E. Manson.
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Drafting of the article: F.B. Hu.
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Critical revision of the article for important intellectual content: F.B. Hu, M.J. Stampfer, C. Solomon, S. Liu, G.A. Colditz, F.E. Speizer, W.C. Willett, J.E. Manson.
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Final approval of the article: F.B. Hu, C. Solomon, S. Liu, G.A. Colditz, F.E. Speizer, W.C. Willett, J.E. Manson.
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Statistical expertise: F.B. Hu, S. Liu, G.A. Colditz, W.C. Willett.
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Obtaining of funding: F.B. Hu, F.E. Speizer, W.C. Willett, J.E. Manson.
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Administrative, technical, or logistic support: F.B. Hu, G.A. Colditz, F.E. Speizer, J.E. Manson.
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Collection and assembly of data: F.B. Hu, G.A. Colditz, W.C. Willett, J.E. Manson.
- Copyright ©2004 by the American College of Physicians
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