The relationship of cardiorespiratory fitness, physical activity, and coronary artery calcification to cardiovascular disease events in CARDIA participants
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Aims: Moderate-to-vigorous-intensity physical activity (MVPA), cardiorespiratory fitness (CRF), and coronary artery calcification (CAC) are associated with cardiovascular disease (CVD) risk. While a U-shaped relationship between CRF or MVPA and CAC has been reported, the presence of CAC among highly fit individuals might be benign. We examined interactive associations of CRF or MVPA and CAC with outcomes and evaluated the relationship of CRF and MVPA to CAC incidence. Methods and results: CARDIA participants with CAC assessed in 2005–06 were included (n = 3,141, mean age 45). MVPA was assessed by self-report and accelerometer. CRF was estimated with a maximal graded exercise test. Adjudicated CVD events and mortality data were obtained through 2019. CAC was reassessed in 2010–11. Cox models were constructed to assess hazard ratios (HRs) for CVD, coronary heart disease (CHD), and mortality in groups defined by CAC presence/absence and lower/higher CRF or MVPA levels. Logistic models were constructed to assess associations with CAC incidence. Adjustment was made for sociodemographic and CVD risk factors. Relative to participants with no CAC and higher CRF, the adjusted HRs for CVD were 4.68 for CAC and higher CRF, 2.22 for no CAC and lower CRF, and 3.72 for CAC and lower CRF. For CHD, the respective HRs were 9.98, 2.28, and 5.52. For mortality, the HRs were 1.15, 1.58, and 3.14, respectively. Similar findings were observed when MVPA measured either by self-report or accelerometer was substituted for CRF. A robust inverse association of CRF and accelerometer-derived MVPA with CAC incidence was partly accounted for by adjusting for CVD risk factors. Conclusion: In middle-aged adults, CRF and MVPA demonstrated an inverse association with CAC incidence, but did not mitigate the increased cardiovascular risk associated with CAC, indicating that CAC is not benign in individuals with higher CRF or MVPA levels.
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Emerging evidence supports the clinical relevance of CAC in athletes.
“Emerging evidence supports the clinical relevance of CAC in athletes.25,26”
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Pauwels, R., Dausin, C., Ruiz-Carmona, S., De Bosscher, R., De Paepe, J., Bekhuis, Y., Delpire, B., Sinnaeve, P., Dymarkowski, S., Ghekiere, O., et al. (2026) · Circulation · doi:10.1161/circulationaha.125.077117 · Cited by 3 · see citing works
- Authors
- Gerber, Y., Gabriel, K. P., Jacobs, D. R., Liu, J. Y., Rana, J. S., Sternfeld, B., Carr, J. J., Thompson, P. D., & Sidney, S.
- Affiliations
- Tel Aviv University (IL)
- University of Alabama at Birmingham (US)
- University of Minnesota (US)
- Kaiser Permanente (US)
- Vanderbilt University Medical Center (US)
- Hartford Hospital (US)
- Corresponding author
- Gerber, Yariv
- ORCID
- Venue
- European Journal of Preventive Cardiology
- Publisher
- Oxford University Press (OUP)
- Published
- 2024-08-19
- Volume
- 32
- Issue
- 1
- Pages
- 52-62
- ISSN
- 2047-4873 (ISSN-L)
- 2047-4881
- PMC
- PMC11700624
- OpenAlex
- W4401686473
- Cited by
- 19
- References
- 5
- Citations by year
- 2026: 10 · 2025: 8 · 2024: 1
- FWCI
- 5.41
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- European Journal of Preventive Cardiology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Coronary Artery Risk Development in Young Adults Study
- CARDIA
- National Heart, Lung, and Blood Institute
- University of Alabama at Birmingham (75N92023D00002, 75N92023D00005)
- Northwestern University (75N92023D00004)
- University of Minnesota (75N92023D00006)
- Kaiser Foundation Research Institute (75N92023D00003, R01HL078972)
- Topics
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Keywords
- cardiorespiratory fitness, moderate-to-vigorous physical activity, coronary artery calcification, cardiovascular disease, coronary artery disease, cardiovascular mortality, middle-aged adults, CARDIA cohort, cardiovascular risk
- MeSH terms
- Cardiorespiratory Fitness, Adult, Cardiovascular Diseases, Coronary Artery Disease, Female, Humans, Male, Middle Aged, Prospective Studies, Risk Factors, Time Factors, United States, Exercise, Incidence, Risk Assessment, Vascular Calcification
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