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Arch Hellen Med, 33(4), July-August 2016, 479-488


Physical activity and 10-year incidence of acute coronary syndrome;
interaction with cardiovascular disease and history of diabetes mellitus

E. Papataxiarchis,1 D.B. Panagiotakos,1 V. Notara,1 M. Kouvari,1 Y. Kogias,3 P. Stravopodis,4 A. Antonoulas,5
G. Papanagnou,5 S. Zombolos,6 Y. Mantas,7 C. Pitsavos;2 for the GREECS Study Investigators, Greece

1Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens,
2First Cardiology Clinic, School of Medicine, National and Kapodistrian University of Athens, Athens,
3Cardiology Clinic, General Hospital of Karditsa, Karditsa,
4Cardiology Clinic, Zakynthos Island General Hospital, Zakynthos,
5Cardiology Clinic, General Hospital of Lamia, Lamia,
6Cardiology Clinic, General Hospital of Kalamata, Kalamata,
7Cardiology Clinic, General Hospital of Chalkida, Chalkida, Greece

OBJECTIVE To evaluate the association between physical activity (PA) status, diabetes mellitus (DM) and long-term (10-years) cardiovascular disease (CVD) prognosis, in patients with acute coronary syndrome (ACS).

METHOD During the initial stage of the Greek study of acute coronary syndromes (GREECS), October 2003–September 2004, 2,172 consecutive patients with ACS from 6 major Greek hospitals were enrolled. In 2013–2014, a 10-year follow up was performed on 1,918 of these patients (88% participation rate). PA was assessed using a self-reporting questionnaire and was categorized as "never", "rarely" (monthly), "1–2 times/week" and "≥3 times/week". DM was defined as fasting glucose levels >125 mg/dL or use of anti-diabetic treatment. Multiple logistic regression analysis was used.

RESULTS Multi-adjusted analysis revealed that 1–2 and ≥3 times/week vs no PA had a protective effect on recurrent ACS incidence (OR=0.63; 95% CI: 0.38, 1.05, and OR=0.63; 95% CI: 0.40, 0.99, respectively), only in patients without a prior baseline CVD event. In a subgroup analysis, for patients with DM, engagement in PA on a weekly basis had a significant protective effect (OR=0.51; 95% CI: 0.27, 0.96, p=0.037), while it was not associated with the 10-year ACS prognosis in non-diabetic patients (p=0.26).

CONCLUSIONS These findings confirmed the beneficial role of exercise in secondary ACS prevention, especially in patients with DM. Public health policies should incorporate regular PA as a key protective factor in CVD.

Key words: Acute coronary syndrome, Diabetes mellitus, History of cardiovascular disease, Physical activity.

© Archives of Hellenic Medicine