Physical Activity, Cardiovascular Status, Mortality, and Prediabetes in Hispanic and Non-Hispanic Adults

Abstract

Importance: Data are limited on the association of physical activity (PA) with incident cardiovascular disease (CVD) and mortality in prediabetes, especially in racial and ethnic minority groups, including Hispanic and Latino populations.

Objective: To determine the association of PA with incident CVD and mortality by prediabetes status among Hispanic or Latino and non-Hispanic adults.

Design, setting, and participants: This cohort study included data from 2 cohorts of adults with prediabetes or normoglycemia who were free of CVD at baseline visit: the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) from baseline examination through 2017, with median (IQR) follow-up of 7.8 (7.2-8.5) years, and the Framingham Heart Study (FHS) with non-Hispanic participants from index examination through 2019, with median (IQR) follow-up of 9.6 (8.1-10.7) years. Analyses were conducted between September 1, 2022, and January 10, 2024.

Exposure: The primary exposure was baseline accelerometry-measured moderate to vigorous PA, insufficient vs sufficient to meet 2018 Physical Activity Guidelines for Americans (PAG) in both cohorts; additional accelerometer-measured exposures in HCHS/SOL were steps per day, sedentary behavior, and counts per min.

Main outcomes and measures: The outcome was a composite of incident CVD or all-cause mortality, whichever came first.

Results: This cohort study included 13 223 participants: from HCHS/SOL, there were 9456 adults (all self-identified Hispanic or Latino ethnicity; survey-adjusted mean [SD] age, 38.3 [13.9] years, unweighted counts 5673 (60.0%) female; 4882 [51.6%] with normoglycemia; 4574 [48.4%] with prediabetes), and from FHS there were 3767 adults (3623 [96.2%] non-Hispanic and 140 [3.7%] Hispanic or Latino ethnicity, with 4 [0.1%] participants missing ethnicity; mean [SD] age, 54.2 [13.6] years; 2128 (56.5%) female; 2739 [72.7%] with normoglycemia; 1028 [27.3%] with prediabetes). Not meeting PAG was associated with higher risk of the composite outcome among participants with normoglycemia (vs PAG met; hazard ratio [HR], 1.85 [95% CI, 1.12-3.06]), but not among participants with prediabetes (HR, 1.07 [95% CI, 0.72-1.58]). For HCHS/SOL, no statistically significant association was found between the composite outcome and other PA metrics, although estimated HRs tended to be higher for lower activity in the normoglycemia group but not for the prediabetes group (eg, for steps less than vs at least 7000 per day, the HR was 1.58 [95% CI, 0.85-2.93] for normoglycemia vs 1.08 [95% CI 0.67-1.74] for prediabetes). While there was also no association in HCHS/SOL between the composite outcome and sedentary behavior, results were similar in the prediabetes group (HR per 30 minutes per day of sedentary behavior, 1.05 [95% CI 0.99-1.12]) and in the normoglycemia group (HR, 1.07 [95% CI 0.98-1.16]).

Conclusions and relevance: In this cohort study of US Hispanic or Latino and non-Hispanic adults, lower moderate to vigorous PA levels were associated with CVD or mortality among participants with normoglycemia but not participants with prediabetes. Adults with prediabetes may benefit from reducing sedentary behavior and improving multiple lifestyle factors beyond improving moderate to vigorous PA alone.

Figure 1.. Sample Derivation for Hispanic Community Health Study/Study of Latinos (HCHS/SOL) and Framingham Heart Study (FHS)

CVD indicates cardiovascular disease; Gen, generation; MVPA, moderate to vigorous physical activity; NOS, new offspring spouses.

Figure 2.. Hazard Ratios for the Composite Outcome of All-Cause Mortality and Incident Cardiovascular Disease With Sufficient (Reference) vs Insufficient (Exposure) Moderate to Vigorous Physical Activity to Meet 2018 Physical Activity Guidelines, by Glycemic Status in the Framingham Heart Study (FHS) and Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

The meta-analysis combined glycemic groups across both studies using the random-effects DerSimonian and Laird model. The overall test of group differences shown is for prediabetes vs normoglycemia (see Methods for details). The estimates of between-study variance (τ²) are imprecise with only 2 studies. PAG indicates Physical Activity Guidelines for Americans.

Figure 3.. Association of the Composite Outcome of All-Cause Mortality or First Incident Cardiovascular Disease Event With Each Tertile of Physical Activity (PA) or Sedentary Behavior Exposure by Glycemic Status in the Hispanic Community Health Study/Study of Latinos

Data from 9456 participants were analyzed except for steps (n = 9421). All models were adjusted for complex survey design. Reference levels were set to be the highest PA or lowest sedentary behavior level. Cutoffs for moderate to vigorous PA (MVPA) were mean minutes per day of 9.33 or lower for low, more than 9.33 to 26.00 for middle, and more than 26.00 for high. Cutoffs for mean counts per minute (CPM) were 116 or lower for low, 116 to 189 for middle, and higher than 189 for high. Cutoffs for mean steps per day were 5090 or fewer for low, 5090 to 8460 for middle, and more than 8460 for high. Cutoffs for sedentary behavior were mean minutes per day of 607 or less, more than 607 to 780 for middle, and more than 780 for high. HR indicates hazard ratio.