Association between physical activity changes and incident myocardial infarction after ischemic stroke: a nationwide population-based study.

Background: The impact of changes in physical activity after ischemic stroke (IS) on the subsequent myocardial infarction (MI) risk is not fully understood. We aimed to investigate the effects of changes in physical activity on the risk of MI after acute IS using data from the Korean National Health Insurance Services Database. Methods: 224,764 patients newly diagnosed with IS between 2010 and 2016 who underwent two serial biannual health checkups were included. The participants were divided into four categories according to changes in their physical activity: persistent non-exercisers, new exercisers, exercise dropouts, and exercise maintainers. The primary outcome was a new diagnosis of incident MI. Multivariable Cox proportional models were used to assess the effects of changes in exercise habits on the risk of MI. Results: After a median of 4.25 years of follow-up, 6,611 (2.94%) MI cases were observed. After adjusting for confounders, new exercisers and exercise maintainers were significantly associated with a lower risk of incident MI than persistent non-exercisers (aHR, 0.849; 95% CI, 0.792–0.911; P-value < 0.001; and aHR, 0.746; 95% CI, 0.696–0.801; P-value < 0.001, respectively). Effects were consistent across sexes, more pronounced in those > 65 years. Notably, any level of physical activity after stroke was associated with a reduced MI risk compared to no exercise. Conclusions: In this nationwide cohort study, commencing or sustaining physical activity after an IS corresponded to a diminished likelihood of subsequent MI development. Advocating physical activity in ambulatory stroke survivors could potentially attenuate the prospective risk of MI. What is New? • Initiating or maintaining regular physical activity following an ischemic stroke (IS) diagnosis significantly reduces the risk of myocardial infarction (MI), regardless of physical activity intensity, age, or sex. • This large-scale cohort study emphasizes the crucial role of physical activity in post-stroke care and secondary prevention, offering a novel perspective on the relationship between physical activity and post-IS cardiovascular outcomes. What are the Clinical Implications? • Healthcare practitioners should prioritize promoting physical activity as an integral component of post-stroke care for older adults, aiming to reduce MI risk. • The findings underscore the importance of regular physical activity for both IS and MI prevention and highlight the potential for improved patient outcomes through lifestyle modifications. [ABSTRACT FROM AUTHOR]

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