Joint effect of physical activity and body mass index on mortality for acute myocardial infarction in the elderly: Role of preinfarction angina as equivalent of ischemic preconditioning

Pasquale Abete, Francesco Cacciatore, David Della Morte, Francesca Mazzella, Gianluca Testa, Gianluigi Galizia, Domenico De Santis, Giancarlo Longobardi, Nicola Ferrara, Franco Rengo

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

BACKGROUND: Preinfarction angina (PrA), clinical equivalent of ischemic preconditioning, confers protection against in-hospital mortality for acute myocardial infarction (AMI) in adult but not in elderly patients. This study aims to examine the interaction between physical activity and body mass index (BMI) in preserving the cardioprotective effect of PrA in elderly patients with AMI. DESIGN: Elderly patients (≥65 years old) with AMI admitted to Coronary Care Unit. METHODS: Elderly patients with AMI were retrospectively stratified for the presence and absence of PrA, and for quartiles of BMI and physical activity. In-hospital outcomes (death, cardiogenic shock, and reinfarction and creatine kinase-MB peak) were evaluated. RESULTS: In-hospital mortality of 1014 elderly patients with AMI was 19.2% in those with PrA and 22.7% in those without (P=0.18, NS). Mortality further decreased with increased physical activity and reduced BMI, a trend that was not observed in patients without PrA. When physical activity and BMI were considered together, lowest in-hospital mortality was observed in patients with highest physical activity and normal BMI (from 18.2 to 9.6%; P<0.01) with the greatest reduction observed in patients with PrA (from 18.3 to 5.1%; P=0.02). Multivariate analysis showed that PrA did not exert a protective effect in all patients irrespective of physical activity and BMI. A protective role was, however, observed in patients with highest physical activity or normal BMI and reached a maximum protective role in patients who showed both highest physical activity and normal BMI [odds ratio=0.08; 95% confidence interval=0.02-0.72; P<0.01]. CONCLUSION: The cardioprotective effect of PrA was preserved in elderly patients who showed the highest physical activity and a normal BMI.

Original languageEnglish
Pages (from-to)73-79
Number of pages7
JournalEuropean Journal of Cardiovascular Prevention and Rehabilitation
Volume16
Issue number1
DOIs
StatePublished - Feb 1 2009
Externally publishedYes

Fingerprint

Ischemic Preconditioning
Unstable Angina
Body Mass Index
Myocardial Infarction
Exercise
Mortality
Hospital Mortality
MB Form Creatine Kinase
Coronary Care Units
Cardiogenic Shock
Multivariate Analysis

Keywords

  • Elderly
  • Lifestyles
  • Mortality
  • Myocardial infarction
  • Preinfarction angina

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Epidemiology
  • Medicine(all)

Cite this

Joint effect of physical activity and body mass index on mortality for acute myocardial infarction in the elderly : Role of preinfarction angina as equivalent of ischemic preconditioning. / Abete, Pasquale; Cacciatore, Francesco; Della Morte, David; Mazzella, Francesca; Testa, Gianluca; Galizia, Gianluigi; De Santis, Domenico; Longobardi, Giancarlo; Ferrara, Nicola; Rengo, Franco.

In: European Journal of Cardiovascular Prevention and Rehabilitation, Vol. 16, No. 1, 01.02.2009, p. 73-79.

Research output: Contribution to journalArticle

Abete, Pasquale ; Cacciatore, Francesco ; Della Morte, David ; Mazzella, Francesca ; Testa, Gianluca ; Galizia, Gianluigi ; De Santis, Domenico ; Longobardi, Giancarlo ; Ferrara, Nicola ; Rengo, Franco. / Joint effect of physical activity and body mass index on mortality for acute myocardial infarction in the elderly : Role of preinfarction angina as equivalent of ischemic preconditioning. In: European Journal of Cardiovascular Prevention and Rehabilitation. 2009 ; Vol. 16, No. 1. pp. 73-79.
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T1 - Joint effect of physical activity and body mass index on mortality for acute myocardial infarction in the elderly

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AU - Abete, Pasquale

AU - Cacciatore, Francesco

AU - Della Morte, David

AU - Mazzella, Francesca

AU - Testa, Gianluca

AU - Galizia, Gianluigi

AU - De Santis, Domenico

AU - Longobardi, Giancarlo

AU - Ferrara, Nicola

AU - Rengo, Franco

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N2 - BACKGROUND: Preinfarction angina (PrA), clinical equivalent of ischemic preconditioning, confers protection against in-hospital mortality for acute myocardial infarction (AMI) in adult but not in elderly patients. This study aims to examine the interaction between physical activity and body mass index (BMI) in preserving the cardioprotective effect of PrA in elderly patients with AMI. DESIGN: Elderly patients (≥65 years old) with AMI admitted to Coronary Care Unit. METHODS: Elderly patients with AMI were retrospectively stratified for the presence and absence of PrA, and for quartiles of BMI and physical activity. In-hospital outcomes (death, cardiogenic shock, and reinfarction and creatine kinase-MB peak) were evaluated. RESULTS: In-hospital mortality of 1014 elderly patients with AMI was 19.2% in those with PrA and 22.7% in those without (P=0.18, NS). Mortality further decreased with increased physical activity and reduced BMI, a trend that was not observed in patients without PrA. When physical activity and BMI were considered together, lowest in-hospital mortality was observed in patients with highest physical activity and normal BMI (from 18.2 to 9.6%; P<0.01) with the greatest reduction observed in patients with PrA (from 18.3 to 5.1%; P=0.02). Multivariate analysis showed that PrA did not exert a protective effect in all patients irrespective of physical activity and BMI. A protective role was, however, observed in patients with highest physical activity or normal BMI and reached a maximum protective role in patients who showed both highest physical activity and normal BMI [odds ratio=0.08; 95% confidence interval=0.02-0.72; P<0.01]. CONCLUSION: The cardioprotective effect of PrA was preserved in elderly patients who showed the highest physical activity and a normal BMI.

AB - BACKGROUND: Preinfarction angina (PrA), clinical equivalent of ischemic preconditioning, confers protection against in-hospital mortality for acute myocardial infarction (AMI) in adult but not in elderly patients. This study aims to examine the interaction between physical activity and body mass index (BMI) in preserving the cardioprotective effect of PrA in elderly patients with AMI. DESIGN: Elderly patients (≥65 years old) with AMI admitted to Coronary Care Unit. METHODS: Elderly patients with AMI were retrospectively stratified for the presence and absence of PrA, and for quartiles of BMI and physical activity. In-hospital outcomes (death, cardiogenic shock, and reinfarction and creatine kinase-MB peak) were evaluated. RESULTS: In-hospital mortality of 1014 elderly patients with AMI was 19.2% in those with PrA and 22.7% in those without (P=0.18, NS). Mortality further decreased with increased physical activity and reduced BMI, a trend that was not observed in patients without PrA. When physical activity and BMI were considered together, lowest in-hospital mortality was observed in patients with highest physical activity and normal BMI (from 18.2 to 9.6%; P<0.01) with the greatest reduction observed in patients with PrA (from 18.3 to 5.1%; P=0.02). Multivariate analysis showed that PrA did not exert a protective effect in all patients irrespective of physical activity and BMI. A protective role was, however, observed in patients with highest physical activity or normal BMI and reached a maximum protective role in patients who showed both highest physical activity and normal BMI [odds ratio=0.08; 95% confidence interval=0.02-0.72; P<0.01]. CONCLUSION: The cardioprotective effect of PrA was preserved in elderly patients who showed the highest physical activity and a normal BMI.

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KW - Myocardial infarction

KW - Preinfarction angina

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