Physical Activity, Coronary Artery Calcium, and Cardiovascular Outcomes in the Multi-Ethnic Study of Atherosclerosis (MESA)

Abstract

Introduction: Although the inverse relationship between physical activity (PA) and cardiovascular disease (CVD) is well established, observational studies suggest that very high levels of PA may be harmful. This study sought to understand the relationship between PA, coronary artery calcium (CAC), and cardiovascular outcomes among individuals at different levels of risk. Methods: PA and CAC were assessed in 6777 baseline participants of the Multi-Ethnic Study of Atherosclerosis. Total PA in METminutes per week was categorized into quartiles, and CAC was categorized as "low risk" (<100 Agatston units; n = 5180) and "high risk" (≥100 Agatston units; n = 1597). Cox proportional hazard regression analyses and Kaplan-Meier curves were generated to understand relationships between PA and CAC with CVD and all-cause mortality. Results: In low-risk participants in the highest PA quartile, there was a decrease in the adjusted hazard ratio (HR) for CVD (HR, 0.72; 95% confidence interval (CI), 0.56-0.94) and all-cause mortality (HR, 0.69; 95% CI, 0.57-0.84) compared with those in the lowest PA quartile. In high-risk participants in the highest PA quartile, there was a decrease in the adjusted HR for all-cause mortality (HR, 0.59; 95% CI, 0.47-0.74) compared with those in the lowest PA quartile. High PA was not associated with an increased risk of either outcome, regardless of CAC category, sex, or race/ethnicity. Conclusions: Our research suggests that there is no increased risk associated with high levels of PA, even among individuals at high risk of CVD.

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

“…Furthermore, the present study results show no evidence that very high volumes of PA (≥3000 MET-min/wk), even among those with elevated CAC (≥100 AU), are associated with higher mortality among a subsample with mortality surveillance data. These findings are consistent with previous research from the CCLS and others, 14,30 indicating that highly active individuals with elevated CAC do not exhibit greater mortality risk. Nonetheless, there is evidence that engaging in PA could lead to adverse cardiovascular adaptions as well as acute cardiac events (related to exercise) among some individuals.…”

Association of Fine Particulate Matter Constituents with the Predicted 10-Year Atherosclerotic Cardiovascular Disease Risk: Evidence from a Large-Scale Cross-Sectional Study

“…In both Korea and China, researchers found consistent results, reporting that a reduction in the level of physical activity could potentially increase PM 2.5 -attributed CVD risks [30,54]. Previous studies have found physical activity could alleviate oxidative stress and systemic inflammation, decelerate atherosclerosis, repair cardiac autonomic nerve dysfunction, and further reduce PM 2.5 -related ASCVD risk [58][59][60].…”

Coronary Plaque in Athletes

“…German C.A. and colleagues also confirmed these data in 2022, dividing the 6000 MESA trial subjects into two risk categories depending on CAC levels and stratifying them by level of physical activity: both in low-risk (CAC < 100) and high-risk subjects (CAC > 100), an increase in the amount of physical activity was protective against all-cause mortality [32]. Figure 3 summarizes the incidence, progression, and prognosis of CAD in athletes.…”