High and very high volumes of physical activity during follow-up not related to CAC progression: JAMA

The cohort study involving 8771 apparently healthy adults 40 years and older revealed that ongoing leisure-time physical activity (PA), even at high volumes is not related to CAC progression, a marker of atherosclerotic cardiovascular disease (ASCVD).

"High and very high volumes of physical activity during follow-up were unrelated to CAC progression," the researchers reported. Moreover, higher baseline volumes of physical activity were not associated with clinically meaningful CAC at follow-up.

Previous cross-sectional studies have suggested that very high PA levels are associated with a higher prevalence of coronary artery calcium (CAC). However, little is known about the association between high-volume PA and CAC progression. To fill this knowledge gap, Kerem Shuval, The Cooper Institute, Dallas, Texas, and colleagues aimed to explore the association between PA (measured at baseline and during follow-up) and the progression of CAC over time.

The study included data from 8771 apparently healthy women and men 40 years and older with multiple preventive medicine visits at the Cooper Clinic (Dallas, Texas), with a mean follow-up of 7.8 years between the first and last clinic visit. Participants with reported CAC and PA measurements at each visit from 1998 to 2019 were included in the study.

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

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 was estimated using negative binomial regression. Furthermore, proportional hazard regression was used to estimate hazard ratios for baseline PA as a CAC progression predictor to 100 or more Agatston units (AU).

The following were the key findings of the study:

• Among 8771 participants, the mean age at baseline was 50.2 years for men and 51.1 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 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.
• 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 versus less than 1500 MET-min/wk to cross this threshold was 0.84 in men and 1.16 in women.

The findings revealed that physical activity volume was not associated with CAC progression in a large cohort of healthy women and men initially free of overt cardiovascular disease.

"This conclusion is based on the results showing that high and very high PA volumes are not related to the CAC progression (regardless of baseline CAC levels) among this sample of community-dwelling adults," the researchers wrote. "Thus, even high-volume PA likely does not accelerate CAC progression and atherosclerosis burden, though there is a need for additional longitudinal research on more diverse samples."

Reference:

Shuval K, Leonard D, DeFina LF, et al. Physical Activity and Progression of Coronary Artery Calcification in Men and Women. JAMA Cardiol. Published online May 15, 2024. doi:10.1001/jamacardio.2024.0759