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Physical Activity and Progression of Coronary Artery Calcification
Quick Takes
- There is evidence that engaging in high levels of physical activity (PA) can lead to acute coronary events that can be minimized by regular exercise.
- Evidence in cross-sectional studies linked high-volume exercise, such as in marathoners and triathletes, to increased coronary artery calcium (CAC), but increased fitness correlates with lower rates of cardiac events for any given CAC level.
- This study found that PA volume was not associated with progression of CAC in a large cohort of healthy men and women who were initially free of overt CVD. And higher levels of baseline PA within CAC categories were not associated with all-cause or CVD mortality.
Study Questions:
What is the relationship between physical activity (PA) at baseline and during follow-up and progression of coronary artery calcium (CAC) over time?
Methods:
The study was conducted at the preventive medicine Cooper Clinic in Dallas in adults who were self- or employer-referred for preventive care and enrolled in the Cooper Clinic Longitudinal Study. All were healthy men and women aged ≥40 years who had multiple (≥2) preventive medicine visits with a mean [standard deviation (SD)] follow-up time of 7.8 (4.7) years between the first and last clinic visit. Participants with reported PA and CAC (in Agatston units [AU]) measurements at each visit during 1998–2019 were included. PA was measured at baseline and follow-up as continuous variables in units of 500 MET-min/wk or categorical variable (<1500 [referent], 1500-2999 [high], and ≥3000 [very high] MET-min/wk). A PA volume of 3000 MET-min/wk corresponds to approximately 5 hours per week of vigorous-intensity PA, such as running at 6 miles per hour (10 minutes per mile). CAC scores were analyzed as continuous variables, and time to progress to a CAC of ≥100 AU was considered interval censored between clinic visits. In addition, mortality from all causes and cardiovascular disease (CVD) was examined as a secondary outcome among a subsample.
Results:
Among 8,771 participants, the mean (SD) age at baseline was 50.2 (7.3) years for men and 51.1 (7.3) years for women. Mean PA in men was 1247 MET-min/wk at baseline and 1406 MET-min/wk at the last follow-up, and in women 1206 MET-min/wk at baseline and 1283 MET-min/wk at the last follow-up. Statin use increased significantly (men 20-44% and women 9-23%). In men the baseline CAC was 96 (301) and at last follow-up 222 (486), and in women 20 (93) and 48 (158).
At baseline, there was an association between higher PA and higher CAC in men consistent with previous studies. Higher levels of baseline CAC were associated with larger CAC changes and rates of change (in AU/y) for both men and women. The rate of mean CAC progression per year from baseline was 28.5% in men and 32.1% in women, independent of mean PA during the same time. Baseline PA was not associated with CAC progression to a clinically meaningful threshold of ≥100 AU over the follow-up period.
In the subgroup of participants with follow-up for mortality, higher levels of baseline PA within CAC categories were not associated with all-cause or CVD mortality, with the exception of significantly lower all-cause mortality with higher PA in men with a baseline CAC of 1-99 AU (p = 0.04).
Conclusions:
This study found that PA volume was not associated with progression of CAC in a large cohort of healthy men and women who were initially free of overt CVD.
Perspective:
There has been concern that a higher coronary calcium score in persons with greater leisure time PA indicated an increase in atherosclerotic plaque and possibly identified persons who would more likely have a coronary event. This longitudinal study in a very large cohort provides good evidence to refute those hypotheses.
Clinical Topics: Diabetes and Cardiometabolic Disease, Prevention, Exercise
Keywords: Exercise, Plaque, Atherosclerotic
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