title: Reduced risk of myocardial infarction related to active commuting: inflammatory and haemostatic effects are potential major mediating mechanisms.
abstract: BACKGROUND
  Regular physical activity is inversely associated with risk of coronary heart disease, but the precise mechanisms remain unclear. Active commuting is an environmental friendly way to achieve the recommended 30 min of daily physical activity. The aim of this study was to explore the relative contribution of markers from different potential mediating pathways on the association between active commuting and risk of myocardial infarction (MI) in a general population.
  
  
  METHODS
  Prospective incident nested case-control study.
  
  
  METHODS
  Commuting habits, traditional risk factors and biomarkers were assessed at baseline and compared in 204 MI cases and 327 matched controls.
  
  
  RESULTS
  Car commuting was significantly associated with MI risk, even after adjusting for potential confounders (odds ratio: 1.77, 95% confidence interval: 1.05-2.99). When potential mediators were included in the model, the risk was substantially attenuated. Among the traditional risk factors, apolipoprotein B/apolipoprotein A-1 ratio seemed to be the largest mediator (26.0%), followed by body mass index (18.7%). The inflammatory and haemostatic markers similarly dampened the effect, with tissue plasminogen activator/plasminogen activator inhibitor-1 complex and IL-6 explaining 33.6 and 27.6% of MI risk, respectively. Combined, the potential mediators investigated seemed to explain 40.1% of MI risk related to car commuting.
  
  
  CONCLUSIONS
  Overall, the traditional, inflammatory and haemostatic markers seemed to explain a substantial proportion of the reduction in MI risk related to active commuting in this study population. The predominant effect of the inflammatory and haemostatic markers supports the hypothesis that regular physical activity may work through additional biological mechanisms to reduce coronary risk beyond traditional risk factors. However, these findings need to be confirmed in larger studies.
authors.affiliation: Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden. patrik.wennberg@medforskskelet.se
authors.forename: Patrik
authors.initials: P
authors.lastname: Wennberg
authors.forename: Frances
authors.initials: F
authors.lastname: Wensley
authors.forename: Lars
authors.initials: L
authors.lastname: Johansson
authors.forename: Kurt
authors.initials: K
authors.lastname: Boman
authors.forename: Emanuele
authors.initials: E
authors.lastname: Di Angelantonio
authors.forename: Ann
authors.initials: A
authors.lastname: Rumley
authors.forename: Gordon
authors.initials: G
authors.lastname: Lowe
authors.forename: Göran
authors.initials: G
authors.lastname: Hallmans
authors.forename: Jan-Håkan
authors.initials: JH
authors.lastname: Jansson
mesh_terms: D000328:Adult; D016632:Apolipoprotein A-I / Q000097:blood; D001055:Apolipoproteins B / Q000097:blood; D001336:Automobiles; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D016022:Case-Control Studies; D015444:Exercise; D005260:Female; D006487:Hemostasis; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000276:immunology / Q000517:prevention & control*; D016017:Odds Ratio; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D013548:Sweden; D014186:Transportation / Q000379:methods*
chemical_list: C505693:APOA1 protein, human; D016632:Apolipoprotein A-I; D001055:Apolipoproteins B; D015415:Biomarkers; D018836:Inflammation Mediators