Physical Activity Is Inversely Associated With Severe Intracranial Stenosis in Stroke-Free Participants of NOMAS

Abstract

Background: Although protective in secondary stroke prevention of intracranial arterial stenosis (ICAS), it is uncertain if the benefits of leisure time physical activity (LTPA) extend to asymptomatic ICAS or extracranial carotid stenosis (ECAS). Therefore, we sought to determine LTPA’s relationship with ECAS and ICAS in a stroke-free, race-ethnically diverse cohort. Methods: This cross-sectional study included participants from the magnetic resonance imaging substudy of the Northern Manhattan Study, of whom 1274 had LTPA assessments at enrollment. LTPA was represented continuously as metabolic equivalent score (MET-score) and ordinally as model-based cluster analysis (LTPA-cluster), both based on the same LTPA assessments. We evaluated ECAS sonographically using carotid intima-media thickening and number of carotid plaques. ICAS was assessed with time-of-flight magnetic resonance angiograph and defined as ≥50% or ≥70% stenosis. We applied regression analyses to evaluate the association between LTPA with ECAS and ICAS, adjusting for confounders. Results: Of 1274 included participants (mean age 71±9 years; 60% women; 65% Hispanic), the mean MET-score was 10±16 and 60% were in a LTPA-cluster with any activity. Among those with carotid ultrasound (n=1234), the mean carotid intima-media thickening was 0.97±0.09 mm, and 56% of participants had at least one carotid plaque identified. Among those with magnetic resonance angiograph (n=1211), 8% had ≥50% ICAS and 5% had ≥70% ICAS. For ICAS, MET-score was associated with ≥70% ICAS (adjusted odds ratio per unit increase in MET-score [95% CI, 0.97 [0.94–0.99]) but not with ECAS measures (carotid intima-media thickening, adjusted β-estimate per unit increase in MET-score [95% CI], 0.002 [−0.003 to 0.006] or number of plaques, adjusted β-estimate [95% CI], 0.0001 [−0.0001 to 0.0003]). Substituting MET-score with LTPA-clusters replicated the association between ≥70% ICAS and LTPA (adjusted odds ratio per each increased LTPA-cluster [95% CI], 0.83 [0.70–0.99]). Conclusions: In this diverse stroke-free population, we found LTPA most strongly associated with asymptomatic ≥70% ICAS. Given the high-risk nature of ≥70% ICAS, these findings may emphasize the role of LTPA in people at risk for ICAS.

The 2023 Taiwan Stroke Society Guidelines for the management of patients with intracranial atherosclerotic disease

“…67–69 In a recently published cross-sectional study including participants from the MRI of the Northern Manhattan Study, of whom 1274 had leisure time physical activity (LTPA) assessments at enrollment, showed that LTPA was strongly associated with asymptomatic ≥70% intracranial artery stenosis (95% CI, 0.94-0.99. 70 In the Stenting and Aggressive Medical Management for Prevention of Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial, patients with 70% to 99% stenosis of intracranial arteries were strictly controlled for risk factors and were divided into medical therapy group and stenting group. The risk factor control strategies in the study included keeping systolic blood pressure <140 mmHg (<130 mmHg if diabetic), maintaining LDL <70 mg/dL and HbA1c <7%, cessation of smoking, losing weight, and physical activity.…”

“…[67][68][69] In a recently published cross-sectional study including participants from the MRI of the Northern Manhattan Study, of whom 1274 had leisure time physical activity (LTPA) assessments at enrollment, showed that LTPA was strongly associated with asymptomatic ≥70% intracranial artery stenosis (95% CI, 0.94-0.99. 70 The results suggested that aggressive medical therapy combined with risk factor management was associated with better outcomes than intracranial stenting. 33,71 Specifically, greater physical activity decreased the likelihood of a recurrent stroke, myocardial infarction, or vascular death.…”

Physical Inactivity Is a Risk Factor for Cardiovascular Stenosis in Stroke-Free People

“…The clear association between physical activity and vascular health in a stroke-free population of older people, shown by Yang et al, 2 is highly important. The inactivity level was higher than in most areas of the United States, but Northern Manhattan is an urban area with a city environment.…”

“…NOMAS 2 is an urban cohort with mixed ethnical background. Forty % of the 1274 included participants were inactive.…”

“…Earlier studies show diverging results on the impact of physical activity and carotid stenosis. Yang et al, 2 from the NOMAS study (Northern Manhattan Study), investigated the impact of physical activity on the vascular system, specifically asymptomatic carotid atherosclerosis (both extracranial and intracranial) in a stroke-free, multiethnical cohort, with good data on sociodemographic factors and using well-validated and reproducible measures of external caortid artery steonosis and internal carotid artery stenosis. Physical activity level was assessed with a standardized questionnaire regarding the duration and frequency of with 14 different recreational activities, 2 weeks before the enrollment.…”