Table 1.
Subgroup analyses of total physical activity, leisure-time physical activity and cardiorespiratory fitness and heart failure risk, high versus low analysis
| Total physical activity | Leisure-time physical activity | Cardiorespiratory fitness | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| n | RR (95% CI) | I2 (%) | Pah | Pbh | n | RR (95% CI) | I2 (%) | Pah | Pbh | n | RR (95% CI) | I2 (%) | Pah | Pbh | |
| All studies | 7 | 0.77 (0.70–0.85) | 48.7 | 0.07 | 16 | 0.74 (0.68–0.81) | 88.0 | < 0.0001 | 6 | 0.31 (0.19–0.49) | 96.1 | < 0.0001 | |||
| Duration of follow-up | |||||||||||||||
| < 10 years follow-up | 1 | 0.81 (0.62–1.08) | 0.79 | 6 | 0.72 (0.59–0.88) | 92.7 | < 0.0001 | 0.85 | 3 | 0.23 (0.14–0.39) | 84.9 | < 0.0001 | 0.19 | ||
| ≥ 10 years follow-up | 6 | 0.77 (0.69–0.86) | 56.1 | 0.04 | 10 | 0.75 (0.69–0.82) | 67.9 | 0.001 | 3 | 0.40 (0.22–0.74) | 96.4 | < 0.0001 | |||
| Sex | |||||||||||||||
| Men | 3 | 0.76 (0.66–0.87) | 35.1 | 0.21 | 0.93/0.89c | 9 | 0.79 (0.71–0.89) | 87.1 | < 0.0001 | 0.20/0.48c | 4 | 0.42 (0.28–0.62) | 83.3 | < 0.0001 | 0.03/0.40c |
| Women | 3 | 0.79 (0.64–0.99) | 81.1 | 0.005 | 10 | 0.73 (0.61–0.86) | 93.3 | < 0.0001 | 2 | 0.31 (0.19–0.50) | 2.5 | 0.31 | |||
| Men and women | 3 | 0.79 (0.67–0.93) | 0 | 0.45 | 5 | 0.69 (0.59–0.80) | 45.4 | 0.12 | 2 | 0.20 (0.13–0.31) | 84.8 | 0.01 | |||
| Geographic location | |||||||||||||||
| Europe | 5 | 0.78 (0.69–0.88) | 62.8 | 0.03 | 0.99 | 7 | 0.80 (0.73–0.88) | 82.0 | < 0.0001 | 0.05 | 3 | 0.44 (0.30–0.67) | 68.2 | 0.04 | 0.11 |
| America | 1 | 0.65 (0.46–0.91) | 9 | 0.70 (0.64–0.76) | 43.6 | 0.08 | 3 | 0.24 (0.16–0.34) | 85.1 | 0.001 | |||||
| International | 1 | 0.81 (0.61–1.08) | 0 | 0 | |||||||||||
| Number of cases | |||||||||||||||
| Cases < 250 | 0 | 0.93 | 1 | 0.41 (0.22–0.74) | 0.26 | 2 | 0.36 (0.19–0.69) | 64.0 | 0.10 | 0.70 | |||||
| Cases 250– < 1000 | 3 | 0.79 (0.67–0.93) | 0 | 0.45 | 2 | 0.75 (0.61–0.92) | 0 | 0.71 | 0 | ||||||
| Cases ≥ 1000 | 4 | 0.77 (0.68–0.88) | 69.0 | 0.02 | 12 | 0.75 (0.68–0.83) | 90.5 | < 0.0001 | 4 | 0.29 (0.16–0.52) | 97.6 | < 0.0001 | |||
| Study quality | |||||||||||||||
| 0–3 | 0 | 0.75 | 0 | 0.82 | 0 | NC | |||||||||
| 4–6 | 1 | 0.81 (0.61–1.08) | 1 | 0.78 (0.58–1.07) | 0 | ||||||||||
| 7–9 | 6 | 0.77 (0.69–0.86) | 56.1 | 0.04 | 15 | 0.74 (0.67–0.81) | 88.7 | < 0.0001 | 6 | 0.32 (0.19–0.53) | 96.8 | < 0.0001 | |||
| Adjustment for confounding factors | |||||||||||||||
| Age | |||||||||||||||
| Yes | 7 | 0.77 (0.70–0.85) | 48.7 | 0.07 | NC | 16 | 0.74 (0.68–0.81) | 88.0 | < 0.0001 | NC | 6 | 0.31 (0.19–0.49) | 96.1 | < 0.0001 | NC |
| No | 0 | 0 | 0 | ||||||||||||
| Education | |||||||||||||||
| Yes | 5 | 0.74 (0.68–0.82) | 30.5 | 0.22 | 0.48 | 11 | 0.74 (0.68–0.81) | 70.6 | < 0.0001 | 0.82 | 1 | 0.55 (0.51–0.59) | 0.15 | ||
| No | 2 | 0.79 (0.58–1.08) | 64.6 | 0.09 | 5 | 0.73 (0.60–0.89) | 87.8 | < 0.0001 | 5 | 0.27 (0.19–0.37) | 80.7 | < 0.0001 | |||
| Family history of heart failure/CVD | |||||||||||||||
| Yes | 3 | 0.76 (0.69–0.84) | 0 | 0.40 | 0.84 | 3 | 0.84 (0.79–0.89) | 0 | 0.69 | 0.11 | 1 | 0.55 (0.51–0.59) | 0.15 | ||
| No | 4 | 0.77 (0.65–0.91) | 69.1 | 0.02 | 13 | 0.71 (0.63–0.81) | 90.3 | < 0.0001 | 5 | 0.27 (0.19–0.37) | 80.7 | < 0.0001 | |||
| Body mass index | |||||||||||||||
| Yes | 6 | 0.77 (0.69–0.86) | 56.1 | 0.04 | 0.79 | 9 | 0.76 (0.69–0.83) | 69.9 | 0.001 | 0.72 | 5 | 0.32 (0.19–0.53) | 96.8 | < 0.0001 | 0.71 |
| No | 1 | 0.81 (0.61–1.08) | 7 | 0.73 (0.62–0.86) | 91.8 | < 0.0001 | 1 | 0.25 (0.13–0.45) | |||||||
| Waist circumference, or waist-to-hip ratio | |||||||||||||||
| Yes | 2 | 0.80 (0.65–0.99) | 75.5 | 0.04 | 0.63 | 2 | 0.75 (0.59–0.95) | 75.9 | 0.04 | 0.92 | 0 | NC | |||
| No | 5 | 0.75 (0.66–0.85) | 35.1 | 0.19 | 14 | 0.74 (0.67–0.82) | 89.0 | < 0.0001 | 6 | 0.31 (0.19–0.49) | 96.1 | < 0.0001 | |||
| Smoking | |||||||||||||||
| Yes | 6 | 0.78 (0.70–0.87) | 54.6 | 0.05 | 0.41 | 11 | 0.73 (0.67–0.80) | 75.4 | < 0.0001 | 0.43 | 4 | 0.27 (0.19–0.39) | 85.5 | < 0.0001 | 0.41 |
| No | 1 | 0.65 (0.46–0.91) | 5 | 0.77 (0.65–0.92) | 81.1 | < 0.0001 | 2 | 0.39 (0.18–0.85) | 83.6 | 0.01 | |||||
| Alcohol | |||||||||||||||
| Yes | 4 | 0.72 (0.66–0.78) | 21.2 | 0.28 | 0.04 | 9 | 0.75 (0.68–0.82) | 77.2 | < 0.0001 | 0.91 | 1 | 0.49 (0.30–0.80) | 0.39 | ||
| No | 3 | 0.87 (0.77–0.99) | 0 | 0.81 | 7 | 0.72 (0.61–0.84) | 86.7 | < 0.0001 | 5 | 0.28 (0.17–0.48) | 96.9 | < 0.0001 | |||
| Hypertension | |||||||||||||||
| Yes | 4 | 0.79 (0.69–0.91) | 49.5 | 0.11 | 0.59 | 10 | 0.77 (0.70–0.86) | 87.0 | < 0.0001 | 0.12 | 2 | 0.20 (0.13–0.31) | 84.8 | < 0.0001 | 0.08 |
| No | 3 | 0.74 (0.64–0.87) | 42.6 | 0.18 | 6 | 0.69 (0.63–0.75) | 22.2 | 0.26 | 4 | 0.40 (0.27–0.59) | 86.7 | < 0.0001 | |||
| Diabetes mellitus | |||||||||||||||
| Yes | 5 | 0.76 (0.67–0.85) | 61.0 | 0.04 | 0.51 | 9 | 0.76 (0.69–0.83) | 70.2 | 0.001 | 0.59 | 4 | 0.27 (0.19–0.39) | 85.5 | < 0.0001 | 0.41 |
| No | 2 | 0.83 (0.69–1.00) | 0 | 0.80 | 7 | 0.72 (0.61–0.87) | 91.7 | < 0.0001 | 2 | 0.39 (0.18–0.85) | 83.6 | 0.01 | |||
| Triglycerides | |||||||||||||||
| Yes | 0 | NC | 4 | 0.75 (0.65–0.87) | 86.2 | < 0.0001 | 0.86 | 0 | NC | ||||||
| No | 7 | 0.77 (0.70–0.85) | 48.7 | 0.07 | 12 | 0.74 (0.65–0.83) | 86.8 | < 0.0001 | 6 | 0.31 (0.19–0.49) | 96.1 | < 0.0001 | |||
| Serum cholesterol | |||||||||||||||
| Yes | 2 | 0.74 (0.60–0.91) | 61.7 | 0.11 | 0.44 | 4 | 0.78 (0.63–0.96) | 94.1 | < 0.0001 | 0.45 | 1 | 0.32 (0.25–0.41) | 0.95 | ||
| No | 5 | 0.79 (0.71–0.89) | 33.3 | 0.20 | 12 | 0.73 (0.67–0.80) | 68.3 | < 0.0001 | 5 | 0.31 (0.17–0.54) | 96.6 | < 0.0001 | |||
| Prevalent coronary heart disease | |||||||||||||||
| Yes | 3 | 0.73 (0.65–0.81) | 43.2 | 0.17 | 0.13 | 4 | 0.82 (0.73–0.91) | 50.1 | 0.11 | 0.29 | 2 | 0.27 (0.09–0.82) | 93.4 | < 0.0001 | 0.66 |
| No | 4 | 0.84 (0.75–0.94) | 0 | 0.41 | 12 | 0.73 (0.65–0.82) | 90.7 | < 0.0001 | 4 | 0.33 (0.20–0.54) | 95.8 | < 0.0001 | |||
| Interim coronary heart disease | |||||||||||||||
| Yes | 0 | NC | 1 | 0.82 (0.70–0.96) | 0.51 | 1 | 0.55 (0.51–0.59) | 0.15 | |||||||
| No | 7 | 0.77 (0.70–0.85) | 48.7 | 0.07 | 15 | 0.74 (0.67–0.81) | 88.8 | < 0.0001 | 5 | 0.27 (0.19–0.37) | 80.7 | < 0.0001 | |||
| Valvular heart disease | |||||||||||||||
| Yes | 2 | 0.68 (0.61–0.75) | 0 | 0.80 | 0.09 | 2 | 0.80 (0.70–0.91) | 0 | 0.52 | 0.59 | 1 | 0.55 (0.51–0.59) | 0.15 | ||
| No | 5 | 0.81 (0.74–0.89) | 19.9 | 0.29 | 14 | 0.73 (0.66–0.81) | 89.4 | < 0.0001 | 5 | 0.27 (0.19–0.37) | 80.7 | < 0.0001 | |||
| Left ventricular hypertrophy | |||||||||||||||
| Yes | 1 | 0.65 (0.46–0.91) | 0.41 | 1 | 0.79 (0.64–0.97) | 0.72 | 0 | 0.57 | |||||||
| No | 6 | 0.78 (0.70–0.87) | 54.6 | 0.05 | 15 | 0.74 (0.67–0.81) | 88.7 | < 0.0001 | 6 | 0.31 (0.19–0.49) | 96.1 | < 0.0001 | |||
| ACE inhibitor use | |||||||||||||||
| Yes | 0 | NC | 0 | NC | 2 | 0.20 (0.13–0.31) | 84.8 | 0.01 | 0.08 | ||||||
| No | 7 | 0.77 (0.70–0.85) | 48.7 | 0.07 | 16 | 0.74 (0.68–0.81) | 88.0 | < 0.0001 | 4 | 0.40 (0.27–0.59) | 86.7 | < 0.0001 | |||
| Beta-blocker use | |||||||||||||||
| Yes | 0 | NC | 0 | NC | 2 | 0.20 (0.13–0.31) | 84.8 | 0.01 | 0.08 | ||||||
| No | 7 | 0.77 (0.70–0.85) | 48.7 | 0.07 | 16 | 0.74 (0.68–0.81) | 88.0 | < 0.0001 | 4 | 0.40 (0.27–0.59) | 86.7 | < 0.0001 | |||
| Diuretic use | |||||||||||||||
| Yes | 0 | NC | 0 | NC | 2 | 0.20 (0.13–0.31) | 84.8 | 0.01 | 0.08 | ||||||
| No | 7 | 0.77 (0.70–0.85) | 48.7 | 0.07 | 16 | 0.74 (0.68–0.81) | 88.0 | < 0.0001 | 4 | 0.40 (0.27–0.59) | 86.7 | < 0.0001 | |||
| Antihypertensive medication use | |||||||||||||||
| Yes | 1 | 0.65 (0.46–0.91) | 0.41 | 3 | 0.77 (0.60–1.00) | 95.9 | < 0.0001 | 0.54 | 2 | 0.20 (0.13–0.31) | 84.8 | 0.01 | 0.08 | ||
| No | 6 | 0.78 (0.70–0.87) | 54.6 | 0.05 | 13 | 0.74 (0.68–0.80) | 65.6 | < 0.0001 | 4 | 0.40 (0.27–0.59) | 86.7 | < 0.0001 | |||
| Lipid-lowering medication use | |||||||||||||||
| Yes | 0 | NC | 1 | 0.92 (0.90–0.95) | 0.05 | 2 | 0.20 (0.13–0.31) | 84.8 | 0.01 | 0.08 | |||||
| No | 7 | 0.77 (0.70–0.85) | 48.7 | 0.07 | 15 | 0.73 (0.68–0.79) | 67.0 | < 0.0001 | 4 | 0.40 (0.27–0.59) | 86.7 | < 0.0001 | |||
| CVD medication use | |||||||||||||||
| Yes | 0 | NC | 1 | 0.67 (0.57–0.78) | 0.45 | 2 | 0.25 (0.21–0.30) | 0 | 0.99 | 0.52 | |||||
| No | 7 | 0.77 (0.70–0.85) | 48.7 | 0.07 | 15 | 0.75 (0.68–0.82) | 87.8 | < 0.0001 | 4 | 0.34 (0.19–0.62) | 96.4 | < 0.0001 | |||
NC not calculable
n number of studies
aP for heterogeneity within each subgroup
bP for heterogeneity between subgroups with meta-regression analysis
cP for heterogeneity between men and women (studies with genders combined were excluded)