Personal Activity Intelligence and Ischemic Heart Disease in a Healthy Population: China Kadoorie Biobank Study

Abstract

Background: Personal Activity Intelligence (PAI) is a physical activity metric that translates heart rate during physical activity into a simple score, where a weekly score of 100 or greater is associated with a lower risk of cardiovascular disease and mortality. Here, we prospectively investigated the association between PAI and ischemic heart disease (IHD) mortality in a large healthy population from China.

Methods: Using data from the China Kadoorie Biobank, we studied 443,792 healthy adults (60% women). The weekly PAI score of each participant was estimated based on the questionnaire data and divided into four groups (PAI scores of 0, ≤50, 51-99, or ≥100). Adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for fatal IHD and nonfatal myocardial infraction (MI) related to PAI were estimated using Cox proportional hazard regression analyses.

Results: There were 3050 IHD deaths and 1808 MI events during a median follow-up of 8.2 years (interquartile range, 7.3-9.1; 3.6 million person-years). After adjustments for multiple confounders, a weekly PAI score ≥ 100 was associated with a lower risk of IHD (aHR: 0.91 (95% CI: 0.83-1.00)), compared with the inactive group (0 PAI). The corresponding aHR for MI was 0.94 (95% CI: 0.83-1.05). In participants aged 60 years or older at baseline, the aHR associated with a weekly PAI score ≥ 100 was 0.84 (95% CI, 0.75-0.93) for IHD and 0.84 (95% CI, 0.73-0.98) for MI.

Conclusion: Among healthy Chinese adults, a weekly PAI score of 100 or greater was associated with a lower risk of IHD mortality across all age groups; moreover, a high PAI score significantly lowered the risk of MI but only in those 60 years and older at baseline. The present findings extend the scientific evidence that PAI may have prognostic significance in diverse settings for IHD outcomes and suggest that the PAI metric may be useful in delineating the magnitude of weekly physical activity needed to reduce the risk of IHD mortality.

Keywords: Personal Activity Intelligence; activity metric; exercise; ischemic heart disease; myocardial infarction; physical activity.

Figure 1

Hazard ratio of ischemic heart disease mortality associated with Personal Activity Intelligence (PAI) in subgroups of participants. Rectangular bars show the hazard ratios, and error bars represent the 95% confidence interval. Smokers: n = 110,622 with 663 and 290 events in inactive and ≥100 PAI groups, respectively. Overweight/obese: n = 146,128 with 619 and 370 events in inactive and ≥100 PAI groups, respectively. Hypertension: n = 57,364 with 590 and 329 events in inactive and ≥100 PAI groups, respectively. Diabetes: n = 23,688 with 283 and 212 events in inactive and ≥100 PAI groups, respectively. ≥40 years: n = 362,616 with 1899 and 944 events in inactive and ≥100 PAI groups, respectively. ≥60 years: n = 86,484 with 1267 and 702 events in inactive and ≥100 PAI groups, respectively.