Association between change in daily ambulatory activity and cardiovascular events in people with impaired glucose tolerance (NAVIGATOR trial): a cohort analysis

• Published in: The Lancet (British edition) 2014-03, Vol.383 (9922), p.1059-1066
• Main Authors: Yates, Thomas, Dr, Haffner, Steven M, MD, Schulte, Phillip J, PhD, Thomas, Laine, PhD, Huffman, Kim M, MD, Bales, Connie W, PhD, Califf, Robert M, MD, Holman, Rury R, MD, McMurray, John J V, MD, Bethel, M Angelyn, MD, Tuomilehto, Jaakko, MD, Davies, Melanie J, MD, Kraus, William E, MD
• Format: Article
• Language: English
• Subjects: Aged; Biological and medical sciences; Cardiovascular disease; Cardiovascular diseases; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - prevention & control; Cohort Studies; Diabetes; Diabetes. Impaired glucose tolerance; Disease prevention; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Family medical history; Female; General aspects; Glucose; Glucose Intolerance; Health risks; Humans; Internal Medicine; Lifestyles; Longitudinal Studies; Male; Medical sciences; Middle Aged; Miscellaneous; Mortality; Motor Activity; Myocardial infarction; Myocardial Infarction - epidemiology; Myocardial Infarction - prevention & control; Proportional Hazards Models; Prospective Studies; Public health. Hygiene; Public health. Hygiene-occupational medicine; Risk Factors; Stroke - epidemiology; Stroke - prevention & control; Studies; Walking - statistics & numerical data
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(13)62061-9

Summary Background The extent to which change in physical activity can modify the risk of cardiovascular disease in individuals at high cardiovascular risk is uncertain. We investigated whether baseline and change in objectively-assessed ambulatory activity is associated with the risk of a cardiovascular event in individuals at high cardiovascular risk with impaired glucose tolerance. Methods We assessed prospective data from the NAVIGATOR trial involving 9306 individuals with impaired glucose tolerance who were recruited in 40 countries between January, 2002, and January, 2004. Participants also either had existing cardiovascular disease (if age ≥50 years) or at least one additional cardiovascular risk factor (if age ≥55 years). Participants were followed-up for cardiovascular events (defined as cardiovascular mortality, non-fatal stroke, or myocardial infarction) for 6 years on average and had ambulatory activity assessed by pedometer at baseline and 12 months. Adjusted Cox proportional hazard models quantified the association of baseline and change in ambulatory activity (from baseline to 12 months) with the risk of a subsequent cardiovascular event, after adjustment for each other and potential confounding variables. This study is registered with ClinicalTrials.gov NCT00097786. Findings During 45 211 person-years follow-up, 531 cardiovascular events occurred. Baseline ambulatory activity (hazard ratio [HR] per 2000 steps per day 0·90, 95% CI 0·84–0·96) and change in ambulatory activity (0·92, 0·86–0·99) were inversely associated with the risk of a cardiovascular event. Results for change in ambulatory activity were unaffected when also adjusted for changes in body-mass index and other potential confounding variables at 12 months. Interpretation In individuals at high cardiovascular risk with impaired glucose tolerance, both baseline levels of daily ambulatory activity and change in ambulatory activity display a graded inverse association with the subsequent risk of a cardiovascular event. Funding Novartis Pharmaceuticals.