Sedentary Behavior and Cardiovascular Disease in Older Women: The OPACH Study

Bellettiere, John; LaMonte, Michael J.; Evenson, Kelly R.; Rillamas-Sun, Eileen; Kerr, Jacqueline; Lee, I-Min; Di, Chongzhi; Rosenberg, Dori E.; Stefanick, Marcia L.; Buchner, David M.; Hovell, Melbourne F.; LaCroix, Andrea Z.; Rossouw, Jacques; Ludlam, Shari; Burwen, Dale; McGowan, Joan; Ford, Leslie; Geller, Nancy; Anderson, Garnet; Prentice, Ross; Kooperberg, Charles; Manson, JoAnn E.; Howard, Barbara V.; Jackson, Rebecca; Thomson, Cynthia A.; Wactawski-Wende, Jean; Limacher, Marian; Wallace, Robert; Kuller, Lewis; Shumaker, Sally; Shumaker, Sally

doi:10.1161/circulationaha.118.035312

Cited by 252Physical Activity and HealthCardiovascular Health and Risk FactorsCardiovascular and exercise physiology

Sedentary Behavior and Cardiovascular Disease in Older Women: The OPACH Study

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Bellettiere, John, LaMonte, Michael J., Evenson, Kelly R., Rillamas-Sun, Eileen, Kerr, Jacqueline, Lee, I-Min, Di, Chongzhi, Rosenberg, Dori E. +23 more·2019·Circulation

DOI 10.1161/circulationaha.118.035312PMC PMC6481298

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Abstract

Background: Evidence that higher sedentary time is associated with higher risk for cardiovascular disease (CVD) is based mainly on self-reported measures. Few studies have examined whether patterns of sedentary time are associated with higher risk for CVD. Methods: Women from the OPACH Study (Objective Physical Activity and Cardiovascular Health; n=5638, aged 63–97 years, mean age 79±7 years) with no history of myocardial infarction or stroke wore accelerometers for 4 to 7 days and were followed up for up to 4.9 years for CVD events. Average daily sedentary time and mean sedentary bout duration were the exposures of interest. Cox regression models were used to estimate hazard ratios (HRs) and 95% CIs for CVD using models adjusted for covariates and subsequently adjusted for potential mediators (body mass index, diabetes mellitus, hypertension, and CVD risk biomarkers [fasting glucose, high-density lipoprotein, triglycerides, and systolic blood pressure]). Restricted cubic spline regression characterized dose-response relationships. Results: There were 545 CVD events during 19 350 person-years. With adjustment for covariates, women in the highest (≈11 h/d or more) versus the lowest (≈9 h/d or less) quartile of sedentary time had higher risk for CVD (HR, 1.62; 95% CI, 1.21–2.17; P trend <0.001). Further adjustment for potential mediators attenuated but did not eliminate significance of these associations ( P trend <0.05, each). Longer versus shorter mean sedentary bout duration was associated with higher risks for CVD (HR, 1.54; 95% CI, 1.27–2.02; P trend=0.003) after adjustment for covariates. Additional adjustment for CVD risk biomarkers attenuated associations, resulting in a quartile 4 versus quartile 1 HR of 1.36 (95% CI, 1.01–1.83; P trend=0.10). Dose-response associations of sedentary time and bout duration with CVD were linear ( P nonlinear >0.05, each). Women jointly classified as having both high sedentary time and long bout durations had significantly higher risk for CVD (HR, 1.34; 95% CI, 1.08–1.65) than women with low sedentary time and short bout duration. All analyses were repeated for incident coronary heart disease (myocardial infarction or CVD death), and associations were similar, with notably stronger HRs. Conclusions: Both high sedentary time and long mean bout durations were associated in a dose-response manner with increased CVD risk in older women, which suggests that efforts to reduce CVD burden might benefit from addressing either or both components of sedentary behavior.

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Prolonged sedentary time is associated with a 12% higher risk of incidental cardiovascular disease independent of physical activity levels.
“Prolonged sedentary time is also associated with a 12% higher risk of incidental cardiovascular disease (CVD) independent of physical activity levels [1].”
From Feasibility and Preliminary Efficacy of a “Sit Less” Program Leveraging Fitbit Tracking and Tailored Text Messages in Cardiometabolic Disease: Findings From 2 Parallel Randomized Controlled Trials in Coronary Artery Disease and Type 2 Diabetes (2026) · cites this paper as [1]
The Results (page not provided) report a 12% higher CVD risk per additional hour of sedentary time in older women. The association remained significant after adjustment for moderate-to-vigorous physical activity, but was attenuated; the paper does not establish that the 12% estimate itself is independent of physical activity. It also reports a different estimate for prolonged sedentary bouts. (LLM, conf=0.89)
Experimental — accuracy not yet measured
Sedentary behavior is a strong modifiable risk factor for cardiometabolic disease.
“Sedentary behavior is a strong modifiable risk factor for cardiometabolic disease [1,2].”
From Feasibility and Preliminary Efficacy of a “Sit Less” Program Leveraging Fitbit Tracking and Tailored Text Messages in Cardiometabolic Disease: Findings From 2 Parallel Randomized Controlled Trials in Coronary Artery Disease and Type 2 Diabetes (2026) · cites this paper as [1]
The Discussion (page unavailable) reports dose-response associations between sedentary behavior and cardiovascular disease risk in older women and discusses reducing sedentary time. It does not establish sedentary behavior as a causal risk factor for cardiometabolic disease generally; the study’s conclusion is limited to associations with cardiovascular disease in older women. (LLM, conf=0.85)
Experimental — accuracy not yet measured
Physical activity attenuates cardiometabolic risk but does not eliminate the increased risk associated with high sedentary time.
“Emerging evidence suggests that physical activity attenuates cardiometabolic risk but does not eliminate the increased risk associated with high sedentary time [1,6].”
From Feasibility and Preliminary Efficacy of a “Sit Less” Program Leveraging Fitbit Tracking and Tailored Text Messages in Cardiometabolic Disease: Findings From 2 Parallel Randomized Controlled Trials in Coronary Artery Disease and Type 2 Diabetes (2026) · cites this paper as [1]
The Discussion reports that adjusting for moderate-to-vigorous physical activity attenuated the association between sedentary time and CVD risk, but the elevated risk remained significant in older women. This supports the persistence of risk with high sedentary time, but the study does not establish that physical activity itself reduces cardiometabolic risk more broadly. (LLM, conf=0.84)
Experimental — accuracy not yet measured

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Do the Impacts of Mentally Active and Passive Sedentary Behavior on Dementia Incidence Differ by Physical Activity Level? A 5-year Longitudinal Study
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Sleep disturbances in children newly enrolled in elementary school are associated with parenting stress in China.
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Genetic Liability to Sedentary Behavior in Relation to Stroke, Its Subtypes and Neurodegenerative Diseases: A Mendelian Randomization Study
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Longitudinal associations between the frequency of playing Mahjong and cognitive functioning among older people in China: evidence from CLHLS, 2008–2018
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Leisure Sedentary Behavior, Physical Activities, and Cardiovascular Disease Among Individuals With Metabolic Dysfunction–Associated Fatty Liver Disease
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Pharmacological and Clinical Studies of Medicinal Plants That Inhibit Dipeptidyl Peptidase-IV
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Sedentary Behavior and Cardiovascular Disease in Older Women: The OPACH Study
Stefanick, M. L., Buchner, D. M., Evenson, K. R., Bellettiere, J., Lamonte, M. J., Hovell, M. F., Kerr, J., Lee, I.-M. M., Di, C., Rosenberg, D. E., et al. (2021) · Carolina Digital Repository (University of North Carolina at Chapel Hill) · doi:10.17615/ttb8-tg32 · Cited by 4 · see citing works
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Abstract 047: Sedentary Behavior Increases Risk for Cardiovascular Disease in Older Women: The Objective Physical Activity and Cardiovascular Health (OPACH) Study
Bellettiere, J., LaMonte, M. J., Rillamas‐Sun, E., Kerr, J., Evenson, K. R., Lee, I.-M. M., Di, C., Büchner, D. M., Hovell, M. F., & LaCroix, A. Z. (2018) · Circulation · doi:10.1161/circ.137.suppl_1.047 · Cited by 4 · see citing works
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Relationship of Sedentary Behavior and Physical Activity to Incident Cardiovascular Disease
Chomistek, A. K., Manson, J. E., Stefanick, M. L., Lu, B., Sands-Lincoln, M., Going, S. B., Garcia, L., Allison, M. A., Sims, S. T., LaMonte, M. J., et al. (2013) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2013.03.031 · Cited by 389 · see citing works
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Abstract 17035: Dose Response Relationship Between Sedentary Time and Cardiovascular Disease Risk: A Meta-analysis
Salahuddin, U. I., Pandey, A., Ayers, C. R., Kulinski, J. P., Garg, S. K., Kumbhani, D. J., de Lemos, J. A., & Berry, J. D. (2015) · Circulation · doi:10.1161/circ.132.suppl_3.17035
Continuous Dose-Response Association Between Sedentary Time and Risk for Cardiovascular Disease: A Meta-analysis
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Authors: Bellettiere, J., LaMonte, M. J., Evenson, K. R., Rillamas-Sun, E., Kerr, J., Lee, I.-M., Di, C., Rosenberg, D. E., Stefanick, M. L., Buchner, D. M., Hovell, M. F., LaCroix, A. Z., Rossouw, J., Ludlam, S., Burwen, D., McGowan, J., Ford, L., Geller, N., Anderson, G., Prentice, R., Kooperberg, C., Manson, J. E., Howard, B. V., Jackson, R., Thomson, C. A., Wactawski-Wende, J., Limacher, M., Wallace, R., Kuller, L., Shumaker, S., & Shumaker, S.
Affiliations: San Diego State University (US)
University at Buffalo, State University of New York (US)
University of North Carolina at Chapel Hill (US)
Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (E.R.-S., C.D.).
University of California San Diego (US)
Brigham and Women's Hospital (US)
Fred Hutch Cancer Center (US)
Group Health Cooperative (US)
Stanford Medicine (US)
University of Illinois at Urbana-Champaign, (D.M.B.).
ORCID: Bellettiere, John
LaMonte, Michael J.
Evenson, Kelly R.
Kerr, Jacqueline
Lee, I-Min
Di, Chongzhi
Rosenberg, Dori E.
Stefanick, Marcia L.
Hovell, Melbourne F.
LaCroix, Andrea Z.
Rossouw, Jacques
Geller, Nancy
Anderson, Garnet
Prentice, Ross
Kooperberg, Charles
Manson, JoAnn E.
Howard, Barbara V.
Thomson, Cynthia A.
Limacher, Marian
Wallace, Robert
Kuller, Lewis
Venue: Circulation
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2019-02-19
Volume: 139
Issue: 8
Pages: 1036-1046
ISSN: 0009-7322 (ISSN-L)
1524-4539
DOI: 10.1161/circulationaha.118.035312
PMC: PMC6481298
OpenAlex: W2916721746
Cited by: 252
References: 50
Citations by year: 2026: 17 · 2025: 25 · 2024: 48 · 2023: 50 · 2022: 45 · 2021: 37 · 2020: 24 · 2019: 6
FWCI: 19.20
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: Circulation (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
Funders: U.S. Department of Health and Human Services (HHSN268201600002 C, HHSN268201600018 C, HHSN268201600003C, TL1TR001443, HHSN268201600004 C, HHSN268201600001 C)
National Institutes of Health (HHSN268201600018C, TL1TR001443, HHSN268201600003C, HHSN268201600004C, HHSN268201600001C, HHSN268201600002C)
National Institute on Aging (P01AG052352, U19AG066567)
National Heart, Lung, and Blood Institute (HHSN268201600018C, HHSN268201600004C, HHSN268201600001C, K23HL119352, HL105065, R01HL105065, HHSN268201600003C, HHSN268201600002C, RO1 HL105065, R01HL130483, T32HL079891)
National Center for Advancing Translational Sciences
Topics: Health Sciences › Medicine › Physiology › Physical Activity and Health
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
Keywords: sedentary behavior, cardiovascular disease, older women, sedentary bout duration, accelerometer-measured sedentary time, cardiovascular risk factors, dose-response relationship, myocardial infarction, stroke, physical activity, sex differences in cardiovascular risk, body mass index, diabetes mellitus, hypertension, dyslipidemia
MeSH terms: Healthy Lifestyle, Age Factors, Aged, Aged, 80 and over, Cardiovascular Diseases, Female, Health Status, Humans, Middle Aged, Prospective Studies, Risk Factors, Time Factors, United States, Exercise, Incidence, Women's Health, Risk Assessment, Risk Reduction Behavior, Sedentary Behavior

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