LIVE-HCM: Vigorous Exercise Not Associated With Increased Risk of Cardiac Events in Patients With HCM

Patients with hypertrophic cardiomyopathy (HCM) who exercised vigorously did not have an increased incidence of serious cardiac events during three years of follow-up compared with patients who exercised moderately or were inactive, according to findings from the LIVE-HCM trial presented at ACC.23/WCC.

Rachel J. Lampert, MD, FACC, et al., enrolled 1,534 patients with HCM (40% female) between the ages of 8 and 60 years (20% younger than 25) in five countries, along with an additional 126 individuals with a genetic variant for HCM but no left ventricular hypertrophy. All participants were surveyed about their exercise habits and symptoms every six months for three years and classified as exercising vigorously (42% of participants), moderately (43%) or inactive (16%).

The study’s primary endpoint, a composite of total mortality, cardiac arrest, ventricular arrhythmia treated with an ICD or fainting likely due to arrhythmia, was experienced by 77 participants, with 44 events occurring in individuals classified as nonvigorous and 33 events in those who vigorously exercise (hazard ratio [HR], 1.01, 90% CI, 0.68-1.48; p=0.98).

Secondary analyses compared the incidence of the composite endpoint between vigorous vs. sedentary groups (HR, 0.77; 90% CI, 0.45-1.30; p=0.41), moderate vs. sedentary (HR, 0.69; 90% CI, 0.40-1.16; p=0.24) and vigorous vs. moderate (HR, 1.12; 90% CI, 0.73-1.71; p=0.66). All events occurred in participants with overt HCM, and none occurred in those who only carried the genetic variant.

Researchers noted that participants were self-selected, with a higher-than-expected percentage of vigorous exercisers. In addition, the majority of participants were cared for at high volume HCM centers.

“In a shared decision-making framework that involves being seen by an experienced HCM physician, our data do not support restriction of vigorous exercise for individuals with HCM,” said Lampert. “We know that exercise is beneficial and an important part of life for many people. Evolving how we think about the exercise practices may allow individuals with HCM to garner the longer-term benefits of exercise as well.”

Clinical Topics: Cardiovascular Care Team, Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Prevention, Sports and Exercise Cardiology, Acute Heart Failure, Exercise

Keywords: ACC Annual Scientific Session, ACC23, Cardiomyopathy, Hypertrophic, Exercise, Life Style, Sports, Drug Therapy, Combination, Secondary Prevention, Heart Failure

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