JACC：老年人进行体力活动可降低心衰风险

NT-proBNP和cTnT是心肌发生应激和损伤后释放的生物标志物，两者水平与心衰发生风险相关，并且可被某些因素调节。但目前对影响这两者的因素，尤其是生活方式因素，在心血管危险因素长期存在的老年人中的影响还不确定。鉴于此，来自马里兰大学心内科的ChristopherR.deFilippi等人进行了一项研究，研究结果发表在2012年12月18日JACC杂志上。作者认为老年人进行体力活动可降低NT-proBNP和cTnT水平以及心力衰竭的发生风险。

该研究为多中心、前瞻性、观察性队列研究，共纳入5888名65岁及以上、无心力衰竭的老年人，其中2933人分入NT-proBNP水平组，1757人分入cTnT水平组。分别检测了cTnT、NT-proBNP的基线水平和随后2到3年的水平；在此基础上，再分别测量了参与者的体力活动，用综合体力活动积分来表示活动强度。

研究结果：NT-proBNP水平比基线水平高出25%，达到190pg/ml，cTnT水平比基线水平高出50%，cTnT基线水平为3pg/ml。综合体力活动积分最高的参与者与综合体力活动积分最低的参与者的NT-proBNP、cTnT水平之比分别为0.5（95%可信区间：0.33到0.77）和0.3（95%可信区间：0.16到0.55）。心肌标志物浓度增加的概率是与体力活动积分成负相关的；此外，体力活动的积分越高，心力衰竭的长期发生率越低，心肌标志物的浓度越高，心力衰竭发生的风险越大。

该研究发现，适度的体力活动对早期的心力衰竭有一定的保护作用，它可以预防心肌的损伤和抑制神经、体液系统的激活。因此，改变长期静坐的生活习惯向体育运动方向转变，有利于降低心肌标志物的水平和心衰发生的风险，并且有利于提高身心健康和生活质量。

DOI:10.1016/j.jacc.2012.08.1006
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Physical Activity, Change in Biomarkers of Myocardial Stress and Injury, and Subsequent Heart Failure Risk in Older Adults

Christopher R. deFilippi, MD⁎, , , James A. de Lemos, MD†, Andrew T. Tkaczuk, BS⁎, Robert H. Christenson, PhD⁎, Mercedes R. Carnethon, PhD‡, David S. Siscovick, MD, MPH§, John S. Gottdiener, MD⁎, Stephen L. Seliger, MD, MS⁎

Objectives The aim of this study was to evaluate the association between physical activity and changes in levels of highly sensitive troponin T (cTnT) and N-terminal pro–B-type natriuretic peptide (NT-proBNP), and the subsequent risk of the development of heart failure (HF) in community-dwelling older adults. Background Higher baseline levels of cTnT and NT-proBNP and increases over time correlate with the risk of HF in older adults. Factors modifying these levels have not been identified. Methods NT-proBNP and cTnT were measured at baseline and 2 to 3 years later in adults 65 years of age and older free of HF participating in the Cardiovascular Health Study. Self-reported physical activity and walking pace were combined into a composite score. An increase was prespecified for NT-proBNP as a >25% increment from baseline to ≥190 pg/ml and for cTnT as a >50% increment from baseline in participants with detectable levels (≥3 pg/ml). Results A total of 2,933 participants free of HF had NT-proBNP and cTnT measured at both time points. The probability of an increase in biomarker concentrations between baseline and follow-up visits was inversely related to the physical activity score. Compared with participants with the lowest score, those with the highest score had an odds ratio of 0.50 (95% confidence interval: 0.33 to 0.77) for an increase in NT-proBNP and an odds ratio of 0.30 (95% confidence interval: 0.16 to 0.55) for an increase in cTnT, after adjusting for comorbidities and baseline levels. A higher activity score associated with a lower long-term incidence of HF. Moreover, at each level of activity, an increase in either biomarker still identified those at higher risk. Conclusions These findings suggest that moderate physical activity has protective effects on early heart failure phenotypes, preventing cardiac injury and neurohormonal activation.