Sex differences in mortality associated with physical activity before and after acute coronary syndrome

Background and aims Sex differences have been suggested in the association between baseline physical activity (PA) and cardiovascular outcomes, with women potentially benefiting more. This study evaluated sex differences in survival benefits of changes in moderate-to-vigorous physical activity (MVPA) before and after acute coronary syndrome (ACS). Methods We analyzed 30,840 patients with an ACS diagnosis (mean age 60 years; men: 25,069, women: 5771) from the National Health Insurance Service. Changes in MVPA before and after ACS were self-reported and categorized as persistently inactive, MVPA initiation, MVPA cessation, or MVPA continuation. Outcomes included all-cause and cardiovascular disease (CVD) mortality. Results Over a median follow-up of 5.8 years, 1349 CVD deaths and 4379 all-cause deaths occurred. MVPA initiation was associated with reduced all-cause mortality in men (Hazard Ratio [HR] = 0.77, 95 % Confidence Interval [CI] 0.64–0.93) and women (HR = 0.57, 95 % CI 0.42–0.79). MVPA continuation was associated with reduced all-cause mortality in men and women: (HR = 0.74, 95 % CI 0.63–0.88) and (HR = 0.58, 95 % CI 0.44–0.77). For CVD mortality, MVPA initiation yielded HRs of 0.84 (95 % CI 0.59–1.19) in men and 0.53 (95 % CI 0.31–0.91) in women; MVPA continuation rendered HRs of 0.71 (95 % CI 0.51–0.99) in men and 0.46 (95 % CI 0.29–0.75) in women. Interaction analyses did not suggest significant sex differences in these associations. Conclusions Initiating or continuing MVPA post-ACS diagnosis is associated with a lower risk of all-cause and CVD mortality, with comparable benefits in men and women; this challenging the notion that women derive greater PA-induced mortality reductions than their male counterparts.