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CLINICAL STUDY: STROKE

Physical activity attenuates the effect of increased left ventricular mass on the risk of ischemic stroke

The Northern Manhattan Stroke Study

Carlos J. Rodriguez, MD, MPH^*, Ralph L. Sacco, MD, MS, Robert R. Sciacca, EngScD^*, Bernadette Boden-Albala, DrPh^,, Shunichi Homma, MDFACC^* and Marco R. Di Tullio, MD^*,*

^* Department of Medicine, Columbia University, New York, New York, USA
Neurological Institute, Columbia University, New York, New York, USA
Division of Epidemiology, Columbia University School of Public Health, New York, New York, USA
Sergievsky Center, College of Physicians & Surgeons, Columbia University, New York, New York, USA

Manuscript received October 4, 2001; revised manuscript received February 1, 2002, accepted February 8, 2002.

^* Reprint requests and correspondence: Dr. Marco R. Di Tullio, Department of Medicine/Division of Cardiology, Columbia University, 622 West 168th Street, PH 3-342, New York, New York 10032, USA.
md42{at}columbia.edu

OBJECTIVES: The goal of this study was to determine whether the risk of ischemic stroke associated with increased left ventricular mass (LVM) is modified by physical activity (PA).

BACKGROUND: Increased LVM is associated with an increased risk for stroke. Physical activity can decrease the risk of stroke and may have variable effects on LVM.

METHODS: We used a case-control study design in a multiethnic population in northern Manhattan, New York, to study 394 case subjects who had a first ischemic stroke and 413 stroke-free control subjects. All subjects were interviewed and two-dimensional echocardiograms obtained to determine LVM.

RESULTS: A sharp increase in risk of ischemic stroke was seen in the highest quartile of LVM (odds ratio [OR]: 6.14 [95% confidence interval {CI}: 3.04 to 12.38]). Thus, increased LVM was defined by the highest quartile of LVM. In multivariate analysis, the effect of increased LVM on the risk of stroke was significantly decreased by the presence of any level of PA versus no PA (OR: 1.59 [95% CI: 0.99 to 2.57] p < 0.07 vs. 3.53 [95% CI: 1.94 to 6.42] p < 0.0001). Although PA decreased the risk of stroke in all patients, the effect was stronger in subjects with increased LVM than among those without increased LVM (p = 0.033).

CONCLUSIONS: Increased LVM is associated with an increased risk of stroke, especially among sedentary patients. Physical activity decreases the risk of stroke among patients with increased LVM to a level comparable to that of patients without increased LVM. Recommending PA may be a nonpharmacologic tool to reduce the stroke risk, especially among patients with increased LVM.

Abbreviations and Acronyms   ADL   Activities of Daily Living   CI   confidence interval   IVS   interventricular septal thickness   LVDD   left ventricular diastolic dimension   LVM   left ventricular mass   METS   metabolic equivalents of the task   NOMASS   Northern Manhattan Stroke Study   OR   odds ratio   PA   physical activity   PWT   posterior wall thickness   QWB   Quality of Well Being

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