Sex differences in the association of wearable accelerometer-derived physical activity with coronary heart disease incidence and mortality

Despite American Heart Association, European Society of Cardiology and World Health Organization (AHA/ESC/WHO) guidelines uniformly recommending 150 min week−1 of moderate-to-vigorous physical activity (MVPA) for both sexes, a substantial ‘gender gap’ persists in exercise capacity and guideline adherence, and its impact on coronary heart disease (CHD) development and prognosis remains underexplored. Here we analyzed the accelerometer-measured MVPA of 80,243 CHD-free participants to assess CHD incidence and 5,169 patients with CHD to evaluate all-cause mortality. Compared with non-adherent counterparts, guideline-adherent participants showed a 22% lower CHD risk in female individuals (hereinafter referred to as females) and a 17% lower CHD risk in male individuals (hereinafter referred to as males; (Pinteraction = 0.009). Notably, females achieved a CHD risk reduction of 30% (hazard ratio (HR) = 0.70) with 250 min week−1 of MVPA, whereas males required 530 min week−1 for comparable benefits. Among patients with CHD, active females experienced greater mortality risk reduction than males (HR = 0.30 versus 0.81; Pinteraction = 0.004). Similar sex differences were observed when analyzing guideline-adhering days (Pinteraction < 0.05). Our findings underscore the value of sex-specific tailored CHD prevention strategies using wearable devices, which may help bridge the ‘gender gap’ by motivating females to engage in physical activity. Chen, Wang, Zhong and colleagues show that females derive greater cardiovascular benefits from guideline-recommended levels of physical activity and require less activity than males to see their beneficial effects.