"Registry studies have some limitations such as the observational design, residual confounding, and confounding by drug indication. In the future, it would be exciting to see a head-to-head randomized trial performed to compare the different NOAC treatments in patients with atrial fibrillation," said Dr Staerk.
Moderate Physical Activity Reduces Risk of Cardiovascular Death
Moderate physical activity is associated with a greater than 50% reduction in cardiovascular death in people older than 65, according to Riitta Antikainen, MD, Professor of Geriatrics at the University of Oulu in Finland. "These results prompt us to investigate the mechanisms through which the Mediterranean diet may protect against death," she said.
The 12-year study in nearly 2,500 adults between ages 65 and 74 found that moderate physical activity reduced the risk of an acute cardiovascular event by more than 30%. High levels of physical activity led to greater risk reductions.
"The role of physical activity in preventing cardiovascular disease [CVD] in people of working age is well established," said Dr. Antikainen. "But relatively little is known about the effect of regular physical activity on CVD risk in older people."
The present study assessed the association between leisure time physical activity and CVD risk and mortality in 2,456 men and women who were enrolled into the National FINRISK Study between 1997 and 2007.
Baseline data collection included self-administered questionnaires on physical activity and other health related behavior, clinical measurements (eg, blood pressure, weight, and height), and laboratory measurements, including serum cholesterol. Participants were followed up until the end of 2013. Deaths were recorded from the National Causes of Death Register, and incident CVD events (ie, coronary heart disease and stroke) were collected from the National Hospital Discharge register.
The researchers classified self-reported physical activity as low, moderate, or high. Low physical activity included reading, watching TV, and working in the household without much physical activity. Moderate physical activity encompassed walking, cycling, or practicing other forms of light exercise (eg, fishing, gardening, hunting) for at least four hours per week. High physical activity included recreational sports (eg, running, jogging, skiing, gymnastics, swimming, or ball games) or intense training or sports competitions for at least three hours per week.
During a median follow-up of 11.8 years, 197 participants died from CVD, and 416 had a first CVD event.
When the researchers assessed the link between physical activity and outcome, they adjusted for other cardiovascular risk factors (ie, blood pressure, smoking, and cholesterol) and social factors (ie, marital status and education). To minimize reverse causality, where worse health leads to less physical activity, patients with coronary heart disease, heart failure, cancer, or prior stroke at baseline were excluded from the analysis.
The investigators found that moderate and high leisure-time physical activity were associated with a 31% and 45% reduced risk of an acute CVD event, respectively. Moderate and high leisure-time physical activity were associated with a 54% and 66% reduction in CVD mortality, respectively.
"Our study provides further evidence that older adults who are physically active have a lower risk of coronary heart disease, stroke, and death from cardiovascular disease. The protective effect of leisure time physical activity is dose dependent. In other words, the more you do, the better. Activity is protective even if you have other risk factors for cardiovascular disease such as high cholesterol," said Dr. Antikainen.