The Benefits of Exercise Aren’t Affected By Family History of Heart Disease

It’s a no-brainer by now that physical activity improves cardiovascular outcomes, and a new analysis of the Atherosclerosis Risk in Communities (ARIC) study finds this to be true regardless of a patient’s family history of heart disease.

Study after study has shown the overwhelming value of exercise in reducing adverse events and prolonging life. Now, this one “shows it’s beneficial if you happen to pick the wrong parents,” Paul D. Thompson, MD (Hartford Hospital, CT), who was not involved in the study, commented to TCTMD.

For the current analysis, which was published online August, 30, 2016, ahead of print in the Journal of the American Heart Association, Roberta Florido, MD (Johns Hopkins University School of Medicine, Baltimore, MD), and colleagues looked at outcomes among 9,996 patients who were free of atherosclerotic CV disease at baseline and were followed for a mean 20.9 years.

Compared with the 90.1% of the population without a family history of premature coronary heart disease, those with a family history had similar levels of physical activity at baseline. Also, there were no differences in rates of physical activity between the two groups over the study period.

Meeting American Heart Association-recommended levels of physical activity was associated with a lower risk of incident atherosclerotic CV disease after adjustment for demographics and lifestyle factors for the overall cohort (HR 0.84; 95% CI 0.74-0.94), but this relationship was not affected by a family history of premature coronary heart disease (P for interaction = 0.680).

No Big Surprise

The study findings “aren’t very surprising,” Thompson said. However, “maybe it’s a little surprising that those people with a bad family history weren’t more physically active [and] weren’t trying to overcome their bad family history,” he added.

But physicians should emphasize exercise in all patients, regardless of their level of risk, Thompson said. “If you have a bad family history, physical activity helps. If you don’t have a bad family history, physical activity helps,” he commented, adding that the best way to prescribe exercise is by using a three-step process.

First, clinicians should ask about physical activity, he said. “The second thing they ought to do is encourage people to exercise a minimum of 30 minutes of brisk walking every day,” he continued. “And then they ought to follow-up.”

Thompson said this process is not being followed consistently in current clinical practice, “and it will be done even worse as physicians see even more patients in shorter periods of time.

“There’s no easy solution to the physical activity issue because we’re in a lot of ways genetically lazy,” he continued, “but physicians have a role in engineering the environment so it’s easier for people to exercise.”

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