Association of Sitting Time with Mortality and Cardiovascular Events in High-Income, Middle-Income, and Low-Income Countries
Importance: High amounts of sitting time are associated with increased risks of cardiovascular disease (CVD) and mortality in high-income countries, but it is unknown whether risks also increase in low- and middle-income countries. Objective: To investigate the association of sitting time with morta...
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American Medical Association
2022
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Online Access: | https://www.scopus.com/inward/record.uri?eid=2-s2.0-85132398328&doi=10.1001%2fjamacardio.2022.1581&partnerID=40&md5=076038ab8abb8891d4e1d69da3a0b423 |
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2-s2.0-85132398328 Li S.; Lear S.A.; Rangarajan S.; Hu B.; Yin L.; Bangdiwala S.I.; Alhabib K.F.; Rosengren A.; Gupta R.; Mony P.K.; Wielgosz A.; Rahman O.; Mazapuspavina M.Y.; Avezum A.; Oguz A.; Yeates K.; Lanas F.; Dans A.; Abat M.E.M.; Yusufali A.; Diaz R.; Lopez-Jaramillo P.; Leach L.; Lakshmi P.V.M.; Basiak-Rasała A.; Iqbal R.; Kelishadi R.; Chifamba J.; Khatib R.; Li W.; Yusuf S. Association of Sitting Time with Mortality and Cardiovascular Events in High-Income, Middle-Income, and Low-Income Countries 2022 JAMA Cardiology 7 8 10.1001/jamacardio.2022.1581 https://www.scopus.com/inward/record.uri?eid=2-s2.0-85132398328&doi=10.1001%2fjamacardio.2022.1581&partnerID=40&md5=076038ab8abb8891d4e1d69da3a0b423 Importance: High amounts of sitting time are associated with increased risks of cardiovascular disease (CVD) and mortality in high-income countries, but it is unknown whether risks also increase in low- and middle-income countries. Objective: To investigate the association of sitting time with mortality and major CVD in countries at different economic levels using data from the Prospective Urban Rural Epidemiology study. Design, Setting, and Participants: This population-based cohort study included participants aged 35 to 70 years recruited from January 1, 2003, and followed up until August 31, 2021, in 21 high-income, middle-income, and low-income countries with a median follow-up of 11.1 years. Exposures: Daily sitting time measured using the International Physical Activity Questionnaire. Main Outcomes and Measures: The composite of all-cause mortality and major CVD (defined as cardiovascular death, myocardial infarction, stroke, or heart failure). Results: Of 105677 participants, 61925 (58.6%) were women, and the mean (SD) age was 50.4 (9.6) years. During a median follow-up of 11.1 (IQR, 8.6-12.2) years, 6233 deaths and 5696 major cardiovascular events (2349 myocardial infarctions, 2966 strokes, 671 heart failure, and 1792 cardiovascular deaths) were documented. Compared with the reference group (<4 hours per day of sitting), higher sitting time (≥8 hours per day) was associated with an increased risk of the composite outcome (hazard ratio [HR], 1.19; 95% CI, 1.11-1.28; Pfor trend <.001), all-cause mortality (HR, 1.20; 95% CI, 1.10-1.31; Pfor trend <.001), and major CVD (HR, 1.21; 95% CI, 1.10-1.34; Pfor trend <.001). When stratified by country income levels, the association of sitting time with the composite outcome was stronger in low-income and lower-middle-income countries (≥8 hours per day: HR, 1.29; 95% CI, 1.16-1.44) compared with high-income and upper-middle-income countries (HR, 1.08; 95% CI, 0.98-1.19; P for interaction =.02). Compared with those who reported sitting time less than 4 hours per day and high physical activity level, participants who sat for 8 or more hours per day experienced a 17% to 50% higher associated risk of the composite outcome across physical activity levels; and the risk was attenuated along with increased physical activity levels. Conclusions and Relevance: High amounts of sitting time were associated with increased risk of all-cause mortality and CVD in economically diverse settings, especially in low-income and lower-middle-income countries. Reducing sedentary time along with increasing physical activity might be an important strategy for easing the global burden of premature deaths and CVD. © 2022 American Medical Association. All rights reserved. American Medical Association 23806583 English Article All Open Access; Green Open Access |
author |
Li S.; Lear S.A.; Rangarajan S.; Hu B.; Yin L.; Bangdiwala S.I.; Alhabib K.F.; Rosengren A.; Gupta R.; Mony P.K.; Wielgosz A.; Rahman O.; Mazapuspavina M.Y.; Avezum A.; Oguz A.; Yeates K.; Lanas F.; Dans A.; Abat M.E.M.; Yusufali A.; Diaz R.; Lopez-Jaramillo P.; Leach L.; Lakshmi P.V.M.; Basiak-Rasała A.; Iqbal R.; Kelishadi R.; Chifamba J.; Khatib R.; Li W.; Yusuf S. |
spellingShingle |
Li S.; Lear S.A.; Rangarajan S.; Hu B.; Yin L.; Bangdiwala S.I.; Alhabib K.F.; Rosengren A.; Gupta R.; Mony P.K.; Wielgosz A.; Rahman O.; Mazapuspavina M.Y.; Avezum A.; Oguz A.; Yeates K.; Lanas F.; Dans A.; Abat M.E.M.; Yusufali A.; Diaz R.; Lopez-Jaramillo P.; Leach L.; Lakshmi P.V.M.; Basiak-Rasała A.; Iqbal R.; Kelishadi R.; Chifamba J.; Khatib R.; Li W.; Yusuf S. Association of Sitting Time with Mortality and Cardiovascular Events in High-Income, Middle-Income, and Low-Income Countries |
author_facet |
Li S.; Lear S.A.; Rangarajan S.; Hu B.; Yin L.; Bangdiwala S.I.; Alhabib K.F.; Rosengren A.; Gupta R.; Mony P.K.; Wielgosz A.; Rahman O.; Mazapuspavina M.Y.; Avezum A.; Oguz A.; Yeates K.; Lanas F.; Dans A.; Abat M.E.M.; Yusufali A.; Diaz R.; Lopez-Jaramillo P.; Leach L.; Lakshmi P.V.M.; Basiak-Rasała A.; Iqbal R.; Kelishadi R.; Chifamba J.; Khatib R.; Li W.; Yusuf S. |
author_sort |
Li S.; Lear S.A.; Rangarajan S.; Hu B.; Yin L.; Bangdiwala S.I.; Alhabib K.F.; Rosengren A.; Gupta R.; Mony P.K.; Wielgosz A.; Rahman O.; Mazapuspavina M.Y.; Avezum A.; Oguz A.; Yeates K.; Lanas F.; Dans A.; Abat M.E.M.; Yusufali A.; Diaz R.; Lopez-Jaramillo P.; Leach L.; Lakshmi P.V.M.; Basiak-Rasała A.; Iqbal R.; Kelishadi R.; Chifamba J.; Khatib R.; Li W.; Yusuf S. |
title |
Association of Sitting Time with Mortality and Cardiovascular Events in High-Income, Middle-Income, and Low-Income Countries |
title_short |
Association of Sitting Time with Mortality and Cardiovascular Events in High-Income, Middle-Income, and Low-Income Countries |
title_full |
Association of Sitting Time with Mortality and Cardiovascular Events in High-Income, Middle-Income, and Low-Income Countries |
title_fullStr |
Association of Sitting Time with Mortality and Cardiovascular Events in High-Income, Middle-Income, and Low-Income Countries |
title_full_unstemmed |
Association of Sitting Time with Mortality and Cardiovascular Events in High-Income, Middle-Income, and Low-Income Countries |
title_sort |
Association of Sitting Time with Mortality and Cardiovascular Events in High-Income, Middle-Income, and Low-Income Countries |
publishDate |
2022 |
container_title |
JAMA Cardiology |
container_volume |
7 |
container_issue |
8 |
doi_str_mv |
10.1001/jamacardio.2022.1581 |
url |
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85132398328&doi=10.1001%2fjamacardio.2022.1581&partnerID=40&md5=076038ab8abb8891d4e1d69da3a0b423 |
description |
Importance: High amounts of sitting time are associated with increased risks of cardiovascular disease (CVD) and mortality in high-income countries, but it is unknown whether risks also increase in low- and middle-income countries. Objective: To investigate the association of sitting time with mortality and major CVD in countries at different economic levels using data from the Prospective Urban Rural Epidemiology study. Design, Setting, and Participants: This population-based cohort study included participants aged 35 to 70 years recruited from January 1, 2003, and followed up until August 31, 2021, in 21 high-income, middle-income, and low-income countries with a median follow-up of 11.1 years. Exposures: Daily sitting time measured using the International Physical Activity Questionnaire. Main Outcomes and Measures: The composite of all-cause mortality and major CVD (defined as cardiovascular death, myocardial infarction, stroke, or heart failure). Results: Of 105677 participants, 61925 (58.6%) were women, and the mean (SD) age was 50.4 (9.6) years. During a median follow-up of 11.1 (IQR, 8.6-12.2) years, 6233 deaths and 5696 major cardiovascular events (2349 myocardial infarctions, 2966 strokes, 671 heart failure, and 1792 cardiovascular deaths) were documented. Compared with the reference group (<4 hours per day of sitting), higher sitting time (≥8 hours per day) was associated with an increased risk of the composite outcome (hazard ratio [HR], 1.19; 95% CI, 1.11-1.28; Pfor trend <.001), all-cause mortality (HR, 1.20; 95% CI, 1.10-1.31; Pfor trend <.001), and major CVD (HR, 1.21; 95% CI, 1.10-1.34; Pfor trend <.001). When stratified by country income levels, the association of sitting time with the composite outcome was stronger in low-income and lower-middle-income countries (≥8 hours per day: HR, 1.29; 95% CI, 1.16-1.44) compared with high-income and upper-middle-income countries (HR, 1.08; 95% CI, 0.98-1.19; P for interaction =.02). Compared with those who reported sitting time less than 4 hours per day and high physical activity level, participants who sat for 8 or more hours per day experienced a 17% to 50% higher associated risk of the composite outcome across physical activity levels; and the risk was attenuated along with increased physical activity levels. Conclusions and Relevance: High amounts of sitting time were associated with increased risk of all-cause mortality and CVD in economically diverse settings, especially in low-income and lower-middle-income countries. Reducing sedentary time along with increasing physical activity might be an important strategy for easing the global burden of premature deaths and CVD. © 2022 American Medical Association. All rights reserved. |
publisher |
American Medical Association |
issn |
23806583 |
language |
English |
format |
Article |
accesstype |
All Open Access; Green Open Access |
record_format |
scopus |
collection |
Scopus |
_version_ |
1809678480008282112 |