Physical activity and the progression of coronary artery calcification

Abstract

BackgroundThe association of physical activity with the development and progression of coronary artery calcium (CAC) scores has not been studied. This study aimed to evaluate the prospective association between physical activity and CAC scores in apparently healthy adults.MethodsProspective cohort study of men and women free of overt cardiovascular disease who underwent comprehensive health screening examinations between 1 March 2011 and 31 December 2017. Baseline physical activity was measured using the International Physical Activity Questionnaire Short Form (IPAQ-SF) and categorised into three groups (inactive, moderately active and health-enhancing physically active (HEPA)). The primary outcome was the difference in the 5-year change in CAC scores by physical activity category at baseline.ResultsWe analysed 25 485 participants with at least two CAC score measurements. The proportions of participants who were inactive, moderately active and HEPA were 46.8%, 38.0% and 15.2%, respectively. The estimated adjusted average baseline CAC scores (95% confidence intervals) in participants who were inactive, moderately active and HEPA were 9.45 (8.76, 10.14), 10.20 (9.40, 11.00) and 12.04 (10.81, 13.26). Compared with participants who were inactive, the estimated adjusted 5-year average increases in CAC in moderately active and HEPA participants were 3.20 (0.72, 5.69) and 8.16 (4.80, 11.53). Higher physical activity was association with faster progression of CAC scores both in participants with CAC=0 at baseline and in those with prevalent CAC.ConclusionWe found a positive, graded association between physical activity and the prevalence and the progression of CAC, regardless of baseline CAC scores.

Associations of long-term physical activity trajectories with coronary artery calcium progression and cardiovascular disease events: results from the CARDIA study

“…CAC scanning is one of the most powerful emerging risk assessment tools, with a wealth of data supporting its ability to enhance cardiovascular risk estimation 8 9. It should be noted that high levels of PA were reported to potentially increase prevalence of CAC and subclinical atherosclerosis 12–14 38. However, descriptions of this relationship mostly relied only on a single-valued PA measurement and focused on endurance athletes, which is not representative of the general population and includes associated parameters (such as specific life habits, nutrition, supplement food or even medication) difficult to disentangle from the effect of the PA per se.…”

“…Coronary artery calcium (CAC) assessed by CT, an established marker of subclinical coronary atherosclerosis, is a strong predictor of cardiovascular morbidity and mortality and a potent CVD risk stratification tool 8 9. Studies examining the relationship between PA and CAC have revealed discordant results during the past decades; with an inverse relationship in several studies10 11 but positive relationship in others,12–14 and U/J-shaped relationship,15 16 or no relationship in some studies 17 18. One of the important flaws existing in most previous cohort studies is that only a single measure of self-reported PA was taken.…”

Coronary artery calcium paradox and physical activity

“…Sung and colleagues address whether the progression of coronary artery calcium is associated with different levels of physical activity in healthy individuals. 5 In a large cohort derived from two South Korean hospitals, 25 485 subjects underwent serial measurement of coronary artery calcium obtained over a median duration of 3 years and assessment of physical activity using the International Physical Activity Questionnaire Short Form. Physical activity was graded by the investigators as: inactive (n=11 920, 47%); moderately active (n=9683, 38%); or health-enhancing physically active (n=3882, 15%), equivalent to running 6.5 km/day.…”

Heartbeat: sex-related inequities versus differences in management and outcomes of patients with cardiovascular disease

“…Another interesting paper in this issue is the study by Sung and colleagues 5 showing a positive, graded association between higher levels of physical activity and a higher prevalence, with more rapid progression, of coronary artery calcification (CAC). These findings were based on a cohort of 25 485 Korean men and women with a median interval between CAC measurements of 3 years.…”

“…Thus, it is possible that an increase in CAC scores reflects a protective response and a transition to a more stable plaque morphology rather than more extensive atherosclerosis. They conclude: 'Sung and colleagues 5 have produced a timely manuscript that highlights the complexity of interpreting coronary artery calcium scores in patients who have implemented recommendations on physical activity or commenced on statin therapy. While proponents would argue that it is an effective tool to screen for subclinical atherosclerosis in asymptomatic individuals, clinicians should be cautious regarding the overuse of this test in otherwise healthy individuals.…”