Title

Association of sitting time with mortality and cardiovascular events in high-income, middle-income, and low-income countries

Authors

Sidong Li, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Scott A. Lear, Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada.
Sumathy Rangarajan, Population Health Research Institute, Hamilton Health Sciences & McMaster University, Hamilton, Ontario, Canada.
Bo Hu, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Lu Yin, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Shrikant I. Bangdiwala, Population Health Research Institute, Hamilton Health Sciences & McMaster University, Hamilton, Ontario, Canada.
Khalid F. Alhabib, Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Annika Rosengren, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Rajeev Gupta, Eternal Heart Care Centre and Research Institute, Jawahar Circle, Jaipur, India.
Prem K. Mony, St John's Medical College & Research Institute, Bangalore, India.
Andreas Wielgosz, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Omar Rahman, University of Liberal Arts, Dhaka, Bangladesh.
M Y. Mazapuspavina, Department of Primary Care Medicine, Faculty of Medicine UiTM Sg Buloh Campus, University Teknologi MARA UiTM, Malaysia.
Alvaro Avezum, International Research Center, Hospital Alemão Oswaldo Cruz and UNISA, São Paulo, Brazil.
Aytekin Oguz, Faculty of Medicine, Department of Internal Medicine, Istanbul Medeniyet University, Istanbul, Turkey.
Karen Yeates, Department of Medicine, Queen's University, Kingston, Ontario, Canada.
Fernando Lanas, Universidad de La Frontera, Temuco, Chile.
Antonio Dans, Department of Medicine, University of the Philippines, Manila, Philippines.
Marc Evans Abat, Division of Adult Medicine, Department of Medicine, Philippine General Hospital, Ermita, Manila, Philippines.
Afzalhussein Yusufali, Hatta Hospital, Dubai Health Authority/Dubai Medical College, Dubai, United Arab Emirates.
Rafael Diaz, Estudios Clínicos Latino América, Instituto Cardiovascular de Rosario, Rosario, Argentina.
Patricio Lopez-Jaramillo, Masira Research Institute, Medical School, Universidad de Santander, Bucaramanga, Colombia.
Lloyd Leach, University of the Western Cape, Bellville, Cape Town, South Africa.
P V. Lakshmi, Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India.
Alicja Basiak-Rasala, Department of Social Medicine, Wrocław Medical University, Wrocław, Poland.
Romaina Iqbal, Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
Roya Kelishadi, Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
Jephat Chifamba, Department of Biomedical Sciences Physiology Unit, University of Zimbabwe, Harare, Zimbabwe.
Rasha Khatib, Advocate Aurora HealthFollow
Wei Li, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Salim Yusuf, Population Health Research Institute, Hamilton Health Sciences & McMaster University, Hamilton, Ontario, Canada.

Affiliations

Advocate Aurora Research Institute

Abstract

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 105 677 participants, 61 925 (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.

Document Type

Article

PubMed ID

35704349


 

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