Cardiorespiratory fitness and coronary artery calcification in women
Open accessAbstract
Introduction Cardiorespiratory fitness (fitness) has been shown to be inversely associated with coronary heart disease morbidity and mortality. The cardioprotective mechanisms of fitness are not well defined. The goal of this study was to assess the relationship between coronary artery calcification as a measure of atherosclerotic burden and fitness in a large population of generally healthy women. Methods 5341 women ages 40-90 years seen between 1997 and 2007 underwent maximal treadmill exercise testing and coronary artery calcium (CAC) scanning. Fitness was reported in METs estimated from maximal treadmill time, grade, and speed. CAC was characterized dichotomously as CAC=0 versus CAC>0, and CAC<100 versus CAC≥100. Multiple logistic regression models were used to calculate the adjusted odds ratio of any CAC (CAC>0) and CAC≥100. Fitness was added to these models continuously and categorically based on standard and sample-specific cut-points. Results With a mean age of 52.0 years, the overall prevalence of detectable CAC was 19.9% and CAC≥100 was 6.8%. Univariable analysis showed a modest inverse relationship between fitness and CAC>0 (24% in low fit versus 19% in high fit, p-trend=0.006), with a similar trend observed for CAC≥100. In multivariable models, age adjustment diminished this association and the relationship was no longer statistically significant after adjustment for traditional risk factors. Conclusions The cardioprotective benefit of fitness does not appear to be mediated by an effect independent of traditional risk factors on the development of calcified coronary atherosclerosis as measured by electron beam tomography.
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Large data from other studies have reported a lack of association between reported physical activity, CAC, and adverse coronary events in exercising females, including endurance athletes.
“Large data from other studies have also reported a lack of association between reported physical activity, CAC, and adverse coronary events in exercising females, including endurance athletes.6 35”
From Resting and exercise-induced occult hypertension and coronary atherosclerosis in male masters endurance athletes (2026) · cites this paper as [35]
The Discussion reports that, in a large sample of women, fitness was not associated with CAC after adjustment for cardiovascular risk factors. But the study measured treadmill-assessed fitness rather than reported physical activity, did not establish a finding for female endurance athletes, and explicitly states that it had no coronary outcomes data (Discussion). (LLM, conf=0.90)
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- Authors
- DeFina, L., Radford, N., Leonard, D., Gibbons, L., & Khera, A.
- Affiliations
- Cooper Institute (US)
- Cooper Clinic (US)
- The University of Texas Southwestern Medical Center (US)
- Corresponding author
- DeFina, Laura
- Venue
- Atherosclerosis
- Publisher
- Elsevier BV
- Published
- 2014-04
- Volume
- 233
- Issue
- 2
- Pages
- 648-653
- ISSN
- 0021-9150 (ISSN-L)
- OpenAlex
- W2099827305
- Cited by
- 21
- References
- 29
- Citations by year
- 2026: 1 · 2024: 3 · 2022: 1 · 2021: 2 · 2020: 2 · 2019: 1 · 2018: 1 · 2017: 2 · 2016: 1 · 2015: 4 · 2014: 3
- FWCI
- 2.61
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Atherosclerosis (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Cooper Clinic
- The Cooper Institute
- Topics
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Keywords
- cardiorespiratory fitness, coronary artery calcification, women, coronary artery disease, treadmill exercise testing, METS, traditional cardiovascular risk factors, cardioprotection
- MeSH terms
- Adult, Aged, Aged, 80 and over, Coronary Artery Disease, Cross-Sectional Studies, Diabetes Mellitus, Exercise Test, Female, Humans, Hypertension, Menopause, Middle Aged, Physical Fitness, Retrospective Studies, Risk Factors, Smoking, Texas, Tomography, X-Ray Computed, Comorbidity, Dyslipidemias, Overweight, Vascular Calcification
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