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(CNN) -- There is growing evidence that increasing muscle strength can be beneficial for the heart and even improve outcome after a heart attack.

Having a higher level of muscle strength in the legs appears to be "strongly associated" with a lower risk of developing heart failure after a heart attack, according to new research presented this month in Prague at the European Society of Cardiology's Heart Failure 2023 scientific congress.

The results have not been published in a peer-reviewed journal, but they highlight the importance of regular exercise and maintaining muscle strength in old age, as muscle mass can decline with age, possibly affecting cardiovascular health, noted Kensuke Ueno and Dr. Kentaro Kamiya. researchers from the Department of Rehabilitation, School of Health Sciences, Kitasato University (Japan) and authors of the new research.

Kamiya explained that after a myocardial infarction, the heart can undergo a process called myocardial remodeling or cardiac remodeling, in which fibrous tissue accumulates, which generates an enlargement of the heart. However, evidence is emerging that exercise-based cardiac rehabilitation can alter the course of such remodeling in ways that improve heart function.

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"Cardiac remodeling is the main cause of heart failure after myocardial infarction," says Kamiya. And myokines, which are peptides or chains of amino acids released by muscle fibers, could play an important role.


"Exercise may help attenuate cardiac remodeling," Kamiya said. "In addition, recent studies have shown that skeletal muscle itself also releases myokines, cytokines that have various effects, such as preventing the progression of atherosclerosis, stabilizing blood pressure, and preventing the development of age-related diseases. Maintaining one's own skeletal muscle could be associated with a lower risk of developing heart failure through this myokine, but the detailed mechanism is unclear."

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"Strength training ... should be recommended."

The researchers analyzed the strength of the quadriceps muscles — in the front of the thighs — of 932 people aged 57 to 74 who had been hospitalized for myocardial infarction between 2007 and 2020. They found that the incidence rate of subsequent heart failure was higher, at 22.9 per 1,000 person-years, among patients whose quadriceps had low strength, compared with an incidence rate of 10.2 per 1,000 person-years among those with high quadriceps strength. Person-years are a measure that represents the number of people in a study multiplied by subsequent years.

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"Quadriceps strength is easy and simple to measure accurately in clinical practice. Our study indicates that quadriceps strength may help identify patients at increased risk of developing heart failure after myocardial infarction, who may receive more intense monitoring," Ueno said in a news release. "The findings need to be replicated in other studies, but suggest that strength training involving the quadriceps muscles should be recommended to patients who have suffered a heart attack to prevent heart failure."

It's not the first time scientists have studied the association between muscle strength and prognosis in people with cardiovascular disease. In 2016, Kamiya and colleagues said in a study published in the American Journal of Cardiology that muscle mass in the upper arms could be associated with survival rates to heart disease.

How to prevent another heart attack?

New research on leg strength validates what is known about heart disease control that muscle strength may play a role in reducing certain risks after cardiac events. In addition, more can be learned about why some people may be more affected than others after a heart attack, said Dr. Shaline Rao, director of Heart Failure Services at NYU Langone Hospital-Long Island, who was not involved in the new study.

"Perhaps what this signal shows in the quadriceps muscle is that there are variations between people that could help us better target therapies. I don't think that's a complete answer. But I think it's helpful to understand," Rao says.

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"This is another piece of information that can help us better understand these people and also argue for who will benefit from strength training, in general, after an event or hospitalization," he said. "These are ways to mix frailty with muscle strength and to really think about how to help older adults living with chronic illnesses or suffering from acute illnesses to approach their rehabilitation appropriately," concludes Dr. Rao.

After a heart attack, there are many steps that can be taken to prevent further heart problems. The American Heart Association recommends taking medication as prescribed, keeping follow-up appointments, participating in cardiac rehabilitation, receiving support from loved ones or connecting with other stroke survivors, and managing risk factors, such as high blood pressure, high cholesterol and diabetes, by taking medication. not smoking, eating healthy and exercising.