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. 2024 Feb 14;58(8):411-420.
doi: 10.1136/bjsports-2023-107663. Online ahead of print.

Physical fitness in male adolescents and atherosclerosis in middle age: a population-based cohort study

Ángel Herraiz-Adillo  1 , Viktor H Ahlqvist  2 , Sara Higueras-Fresnillo  1   3 , Kristofer Hedman  4 , Emil Hagström  5 , Melony Fortuin-de Smidt  6 , Bledar Daka  7 , Cecilia Lenander  8 , Daniel Berglind  2   9 , Carl Johan Östgren  1   10 , Karin Rådholm  1   11 , Francisco B Ortega  12   13 , Pontus Henriksson  14
Affiliations

Physical fitness in male adolescents and atherosclerosis in middle age: a population-based cohort study

Ángel Herraiz-Adillo et al. Br J Sports Med. .

Abstract

Objectives: To examine the associations between physical fitness in male adolescents and coronary and carotid atherosclerosis in middle age.

Methods: This population-based cohort study linked physical fitness data from the Swedish Military Conscription Register during adolescence to atherosclerosis data from the Swedish CArdioPulmonary bioImage Study in middle age. Cardiorespiratory fitness was assessed using a maximal cycle-ergometer test, and knee extension muscular strength was evaluated through an isometric dynamometer. Coronary atherosclerosis was evaluated via Coronary Computed Tomography Angiography (CCTA) stenosis and Coronary Artery Calcium (CAC) scores, while carotid plaques were evaluated by ultrasound. The associations were analysed using multinomial logistic regression, adjusted (marginal) prevalences and restricted cubic splines.

Results: The analysis included 8986 male adolescents (mean age 18.3 years) with a mean follow-up of 38.2 years. Physical fitness showed a reversed J-shaped association with CCTA stenosis and CAC, but no consistent association was observed for carotid plaques. After adjustments, compared with adolescents in the lowest tertile of cardiorespiratory fitness and muscular strength, those in the highest tertile had 22% (OR 0.78; 95% CI 0.61 to 0.99) and 26% (OR 0.74; 95% CI 0.58 to 0.93) lower ORs for severe (≥50%) coronary stenosis, respectively. The highest physical fitness group (high cardiorespiratory fitness and muscular strength) had 33% (OR 0.67; 95% CI 0.52 to 0.87) lower OR for severe coronary stenosis compared with those with the lowest physical fitness.

Conclusion: This study supports that a combination of high cardiorespiratory fitness and high muscular strength in adolescence is associated with lower coronary atherosclerosis, particularly severe coronary stenosis, almost 40 years later.

Keywords: Cardiovascular Diseases.

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Conflict of interest statement

Competing interests: EH reports payments to institution from Pfizer and Amgen, small personal fees from Amgen, NovoNordisk, Bayer and AstraZeneca, small personal fee from Amarin AB for participation on advisory board. He is the co-chair of the Swedish secondary prevention registry and the national coordinator for the trials DalCore DAL301 DalGne, Regeneron R1500-CL-1643 and Aegis II/Perfuse. The remaining authors report no competing interests.

Figures

Figure 1
Figure 1
Associations of cardiorespiratory fitness in adolescence with coronary and carotid atherosclerosis in middle age. Left panel depicts adjusted restricted cubic splines with 95% confidence bands for the association of cardiorespiratory fitness in adolescence with segment involvement score (0–11), CAC score and carotid plaque score (0–2) in middle age. X-axes are trimmed to depict the associations for the 1st to 99th percentile of cardiorespiratory fitness values. Right panel depicts adjusted multinomial regression models with 95% CIs for the association of cardiorespiratory fitness in adolescence with coronary stenosis, CAC score and carotid plaques in middle age. Both splines and multinomial models are adjusted for age at conscription, age at SCAPIS, site in conscription, site in SCAPIS, conscription year, educational status at SCAPIS, BMI at conscription, years of smoking at conscription and knee extension strength. BMI, body mass index; CAC, coronary artery calcium; SCAPIS, Swedish CArdioPulmonary bioImage Study.
Figure 2
Figure 2
Associations of knee extension strength in adolescence with coronary and carotid atherosclerosis in middle age. Left panel depicts adjusted restricted cubic splines with 95% confidence bands for the association of knee extension strength in adolescence with segment involvement score (0–11), CAC score and carotid plaque score (0–2) in middle age. X-axes are trimmed to depict the associations for the 1st to 99th percentile of knee extension strength values. Right panel depicts adjusted multinomial regression models with 95% CIs for the association of knee extension strength in adolescence with coronary stenosis, CAC score and carotid plaques in middle age. Both splines and multinomial models are adjusted for age at conscription, age at SCAPIS, site in conscription, site in SCAPIS, conscription year, educational status at SCAPIS, BMI at conscription, years of smoking at conscription and cardiorespiratory fitness. BMI, body mass index; CAC, coronary artery calcium; SCAPIS, Swedish CArdioPulmonary bioImage Study.
Figure 3
Figure 3
Combined associations of cardiorespiratory fitness and knee extension strength in adolescence with coronary stenosis, CAC score and carotid plaques in middle age. All models depict multinomial regression models with 95% CIs adjusted for age at conscription, age at SCAPIS, site in conscription, site in SCAPIS, conscription year, educational status at SCAPIS, BMI at conscription and years of smoking at conscription. Low categories refer to the first tertile, while high categories refer to the second and third tertiles. BMI, body mass index; CAC, coronary artery calcium; CRF, cardiorespiratory fitness; Strength, knee extension muscular strength; SCAPIS: Swedish CArdioPulmonary bioImage Study.
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