Vigorous intensity exercise linked with greater coronary artery calcification and plaque progression

"Intriguingly, very vigorous intensity exercise was linked with greater coronary artery calcification (CAC) and calcified plaque progression, whereas vigorous intensity exercise was tied to less CAC progression," the researchers wrote.

Exercise training and physical activity were linked with a lower coronary events risk. However, cross-sectional studies in older male and middle-aged athletes showed increased coronary artery calcification and atherosclerotic plaques related to the intensity and amount of lifelong exercise. Vincent L. Aengevaeren, Radboud University Medical Center, Nijmegen, The Netherlands, and colleagues explored the longitudinal relationship between exercise training characteristics and coronary atherosclerosis.

For this purpose, the researchers invited middle-aged and older men from the MARC-1 study (Measuring Athlete's Risk of Cardiovascular Events 1) for follow-up in the MARC-2 study.

The severity and prevalence of plaques and CAC were determined by coronary computed tomography angiography (CTA). Quantification of the intensity (moderate [3 to 6 MET hours per week]; vigorous [6 to 9 MET hours per week]; and very vigorous [≥9 MET hours per week]) and volume (metabolic equivalent of task [MET] hours per week) was done during follow-up. To determine the association between exercise intensity/volume and markers of coronary atherosclerosis, linear and logistic regression analyses were performed.

The researchers reported the following findings:

· The authors included 289 (age 54 years) of the original 318 MARC-1 participants with a mean follow-up of 6.3 years.

· Participants exercised for 41 MET hours per week during follow-up, of which 0% was at moderate intensity, 44% was at a vigorous intensity, and 34% was at very vigorous intensity.

· There was an increase in the prevalence of CAC and the median CAC score from 52% to 71% and 1 to 31, respectively.

· Exercise volume during follow-up was not linked with changes in CAC or plaque.

· Vigorous intensity exercise (per 10% increase) was linked with a lesser increase in CAC score (β, −0.05). In contrast, vigorous exercise was associated with a greater CAC score (β, 0.05 per 10%).

· Very vigorous exercise was also linked with increased odds of dichotomized plaque progression (adjusted odds ratio [aOR], 1.09 per 10% vs 2.04 for highest versus lowest very vigorous intensity tertiles, respectively), and specifically with increased calcified plaques (aOR, 1.07 per 10% vs 2.09 for highest vs lowest tertile, respectively).

"During the 6-year follow-up, exercise intensity but not volume was lined with the progression of coronary atherosclerosis," the authors wrote in their study. "It is intriguing that a very vigorous intensity exercise was linked with greater CAC and calcified plaque progression, whereas vigorous intensity exercise was linked with less CAC progression."

Reference:

The "Exercise Volume Versus Intensity and the Progression of Coronary Atherosclerosis in Middle-Aged and Older Athletes: Findings From the MARC-2 Study" was published in Circulation. DOI: https://doi.org/10.1161/CIRCULATIONAHA.122.061173