Physical Activity and Progression of Coronary Artery Calcification in Men and Women

Abstract

Importance: Prior cross-sectional studies have suggested that very high levels of physical activity (PA) are associated with a higher prevalence of coronary artery calcium (CAC). However, less is known regarding the association between high-volume PA and progression of CAC over time.

Objective: To explore the association between PA (measured at baseline and during follow-up) and the progression of CAC over time.

Design, setting, and participants: This cohort study included data from 8771 apparently healthy men and women 40 years and older who had multiple preventive medicine visits at the Cooper Clinic (Dallas, Texas), with a mean (SD) follow-up time of 7.8 (4.7) years between the first and last clinic visit. Participants with reported PA and CAC measurements at each visit during 1998 to 2019 were included in the study. Data were analyzed from March 2023 to February 2024.

Exposures: PA reported at baseline and follow-up, examined continuously per 500 metabolic equivalent of task minutes per week (MET-min/wk) and categorically: less than 1500, 1500 to 2999, 3000 or more MET-min/wk.

Main outcomes and measures: Negative binomial regression was used to estimate the rate of mean CAC progression between visits, with potential modification by PA volume, calculated as the mean of PA at baseline and follow-up. In addition, proportional hazards regression was used to estimate hazard ratios for baseline PA as a predictor of CAC progression to 100 or more Agatston units (AU).

Results: Among 8771 participants, the mean (SD) age at baseline was 50.2 (7.3) years for men and 51.1 (7.3) years for 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 period. That is, the difference in the rate of CAC progression per year was 0.0% per 500 MET-min/wk for men and women (men: 95% CI, -0.1% to 0.1%; women: 95% CI, -0.4% to 0.5%). Moreover, baseline PA was not associated with CAC progression to a clinically meaningful threshold of 100 AU or more over the follow-up period. The hazard ratio for a baseline PA value of 3000 or more MET-min/wk vs less than 1500 MET-min/wk to cross this threshold was 0.84 (95% CI, 0.66 to 1.08) in men and 1.16 (95% CI, 0.57 to 2.35) in women.

Conclusions and relevance: 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 cardiovascular disease.

Figure 1.. Predicted Mean Coronary Artery Calcification (CAC) vs Time Starting From Age 50, 60, or 70 Years by Physical Activity

Adjusted for baseline and follow-up type of scanner, current smoking, body mass index, glucose, total cholesterol, systolic blood pressure, and statin use. At each starting age (50, 60, or 70 years), higher physical activity was associated with higher CAC, but parallel progression curves show equal relative rates of CAC progression (% per year) for up to 10 years. MET-min/wk indicates metabolic equivalent of task minutes per week.

Figure 2.. Baseline Physical Activity as a Predictor of Coronary Artery Calcification (CAC) Progression to 100 Agatston Units (AU) or Greater Among Men and Women With a CAC Less Than 100 AU at Baseline (n = 7391)

The referent was less than 1500 metabolic equivalent of task minutes per week (MET-min/wk); high physical activity, 1500 to 2999 MET-min/wk; and very high physical activity, 3000 or more MET-min/wk at baseline. This multivariable model was adjusted for age, CAC, type of CAC scanner, current smoking, body mass index, fasting glucose, total cholesterol, systolic blood pressure, and statin use, all at baseline.