Association between physical activity and risk of incident cardiovascular disease in women with novel risk factors: evidence from the UK Biobank cohort

ABSTRACT Background Previous evidence demonstrates an increased risk of incident cardiovascular disease (CVD) in women with early menopause and/or adverse pregnancy outcomes. It also suggests an inverse association between physical activity and risk of incident CVD. However, this association in women with novel risk factors have not been evaluated. Therefore, we aimed to address this hypothesis. Methods We explored the data of 253,300 women without a history of CVD or life limiting conditions from the UK Biobank cohort, we further stratified women with a history of early menopause and/or complicated pregnancy to investigate how the risks affect indent CVD in women. We defined early menopause as any history of natural or surgical (bilateral oophorectomy) menopause < 47 years and adverse pregnancy outcomes as a history of gestational diabetes, hypertensive disorders of pregnancy, stillbirth or ≥ two miscarriages. We then classified women into three categories of physical activity based on their responses to the International Physical Activity Questionnaire. Women with a total MET-min/week of ≥ 3000, ≥ 600 and < 600 were categorised into high, moderate, and low levels of physical activity, respectively. We also assessed the dose-response interaction between physical activity and risk of incident CVD (heart failure (HF), arrhythmia, coronary heart disease (CHD), and stroke) in our population and adjusted all the models for potential CVD risk factors. Results During a median follow-up of 13 years, we found a significant increased risk of incident HF, arrhythmia and CHD in women with early menopause/complicated pregnancy, compared to women without these risk factors. Higher levels of physical activity reduced the risk of incident HF (HR 0.81, 95% CI 0.67 0.97) and arrhythmia (HR 0.84, 95% CI 0.75 0.94), compared to a low levels. Moreover, a moderate level of physical activity attenuated the risk of incident arrhythmia (HR 0.82, 95% CI 0.74 0.92). However, no significant associations were found between physical activity risk of incident stroke or CHD. Conclusion Our study indicates that higher levels of PA significantly attenuate the risk of HF and arrhythmia in women with novel risk factors and should be recommended to women to reduce their increased risk of CVD.