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CLINICAL RESEARCH: CARDIOVASCULAR DISEASE

Screen-Based Entertainment Time, All-Cause Mortality, and Cardiovascular Events

Population-Based Study With Ongoing Mortality and Hospital Events Follow-Up

Emmanuel Stamatakis, PhD, MSc, BSc^_*,_*, Mark Hamer, PhD, MSc, BSc^_* and David W. Dunstan, PhD, BAppSc^,,

^_* Department of Epidemiology and Public Health, University College London, London, United Kingdom
Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
School of Population Health, The University of Queensland, Brisbane, Queensland, Australia
Vario Health Institute, Edith Cowan University, Perth, Western Australia, Australia

Manuscript received February 12, 2010; revised manuscript received May 19, 2010, accepted May 31, 2010.

^_* Reprint requests and correspondence: Dr. Emmanuel Stamatakis, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, United Kingdom (Email: e.stamatakis{at}ucl.ac.uk).

Objectives: The aim of this study was to examine the independent relationships of television viewing or other screen-based entertainment ("screen time") with all-cause mortality and clinically confirmed cardiovascular disease (CVD) events. A secondary objective was to examine the extent to which metabolic (body mass index, high-density lipoprotein and total cholesterol) and inflammatory (C-reactive protein) markers mediate the relationship between screen time and CVD events.

Background: Although some evidence suggests that prolonged sitting is linked to CVD risk factor development regardless of physical activity participation, studies with hard outcomes are scarce.

Methods: A population sample of 4,512 (1,945 men) Scottish Health Survey 2003 respondents (35 years) were followed up to 2007 for all-cause mortality and CVD events (fatal and nonfatal combined). Main exposures were interviewer-assessed screen time (<2 h/day; 2 to <4 h/day; and 4 h/day) and moderate to vigorous intensity physical activity.

Results: Two hundred fifteen CVD events and 325 any-cause deaths occurred during 19,364 follow-up person-years. The covariable (age, sex, ethnicity, obesity, smoking, social class, long-standing illness, marital status, diabetes, hypertension)-adjusted hazard ratio (HR) for all-cause mortality was 1.52 (95% confidence interval [CI]: 1.06 to 2.16) and for CVD events was 2.30 (95% CI: 1.33 to 3.96) for participants engaging in 4 h/day of screen time relative to <2 h/day. Adjusting for physical activity attenuated these associations only slightly (all-cause mortality: HR: 1.48, 95% CI: 1.04 to 2.13; CVD events: HR: 2.25, 95% CI: 1.30 to 3.89). Exclusion of participants with CVD events in the first 2 years of follow-up and previous cancer registrations did not change these results appreciably. Approximately 25% of the association between screen time and CVD events was explained collectively by C-reactive protein, body mass index, and high-density lipoprotein cholesterol.

Conclusions: Recreational sitting, as reflected by television/screen viewing time, is related to raised mortality and CVD risk regardless of physical activity participation. Inflammatory and metabolic risk factors partly explain this relationship.

Key Words: mortality • physical activity • sedentary behavior

Abbreviations and Acronyms   BMI = body mass index   CI = confidence interval   CRP = C-reactive protein   CVD = cardiovascular disease   HDL = high-density lipoprotein   HR = hazard ratio

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