CoChat
Sign Up
Cited by 25Physical Activity and HealthCardiac Imaging and DiagnosticsCardiovascular and exercise physiology

Associations of long-term physical activity trajectories with coronary artery calcium progression and cardiovascular disease events: results from the CARDIA study

Open access
Gao, Jing-Wei, Hao, Qing-Yun, Lu, Liu-Yi, Han, Jia-Jin, Huang, Fei-Fei, Vuitton, Dominique A., Wang, Jing-Feng, Zhang, Shao-Ling +1 more·2022·British Journal of Sports Medicine
DOI 10.1136/bjsports-2021-105092
Open this paper in CoChat — free accountOpen PDF

Abstract

Objective: The study aimed to assess the associations of physical activity (PA) trajectories across a 25-year span with coronary artery calcium (CAC) progression, and subsequent risk of cardiovascular disease (CVD) events. Methods: We included 2497 participants from the Coronary Artery Disease Risk Development in Young Adults study who had computed tomography-assessment of CAC at baseline (year 15: 2000–2001) and follow-up (year 20 or 25) and at least three measures of PA from year 0 to year 25. Long-term PA trajectories were determined by latent class modelling using a validated questionnaire. Results: Among the included participants, 1120 (44.9%) were men, 1418 (56.8%) were white, and the mean (SD) age was 40.4 (3.6) years. We identified three distinct PA trajectories based on PA average levels and change patterns: low (below PA guidelines, n=1332; 53.3%); moderate (meeting and slightly over PA guidelines, n=919; 36.8%) and high (about three times PA guidelines or more, n=246; 9.9%). During a mean (SD) follow-up of 8.9 (2.1) years, 640 (25.6%) participants had CAC progression. Participants in the high PA trajectory group had a higher risk of CAC progression than those in the low PA trajectory group after adjustment for traditional cardiovascular risk factors (HR 1.51; 95% CI 1.18 to 1.94). However, high PA trajectory was not associated with an increased risk of incident CVD events (HR 1.01; 95% CI 0.44 to 2.31) and the incidence of CVD events in participants with CAC progression was similar across all three PA trajectory groups (p=0.736). Conclusion: Long-term PA about three times the guidelines or more is independently associated with CAC progression; however, no additional risk of incident CVD events could be detected.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1136/bjsports-2021-105092

Cites

7 of 7 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Current evidence cannot relate an increased risk of ischaemic heart disease events in endurance athletes.

    “current evidence cannot relate an increased risk of ischaemic heart disease events in endurance athletes.23–26”

    From Lifelong endurance exercise and its relation with coronary atherosclerosis (2023) · cites this paper as [23]

    The Abstract and Discussion report no detected increase in cardiovascular events with long-term high physical activity in the CARDIA cohort. However, the Limitations state that participants rarely reached endurance-athlete activity levels, and the paper reports cardiovascular events as a group rather than a separate result for ischaemic heart disease events in athletes. Page numbers are unavailable in our copy. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 48

  1. Nocon M, Hiemann T, Müller-Riemenschneider F, et al. Association of physical activity with all-cause and cardiovascular mortality: a systematic review and meta-analysis. Eur J Cardiovasc Prev Rehabil 2008;15:239-46. · DOI · Paper page
  2. Piepoli MF, Hoes AW, Agewall S. European Guidelines on cardiovascular disease prevention in clinical practice: the Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts) developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J 2016;2016:2315-81.
  3. Arnett DK, Blumenthal RS, Albert MA. ACC/AHA guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/ American heart association Task force on clinical practice guidelines. Circulation 2019;2019:e596-646.
  4. Detrano R, Guerci AD, Carr JJ, et al. Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med 2008;358:1336-45. · DOI · Paper page
  5. Delaney JAC, Jensky NE, Criqui MH, et al. The association between physical activity and both incident coronary artery calcification and ankle brachial index progression: the multi-ethnic study of atherosclerosis. Atherosclerosis 2013;230:278-83. · DOI · Paper page
  6. Desai MY, Nasir K, Rumberger JA, et al. Relation of degree of physical activity to coronary artery calcium score in asymptomatic individuals with multiple metabolic risk factors. Am J Cardiol 2004;94:729-32. · DOI
  7. Weinberg N, Young A, Hunter CJ, et al. Physical activity, hormone replacement therapy, and the presence of coronary calcium in midlife women. Women Health 2012;52:423-36. · DOI
  8. Laddu DR, Rana JS, Murillo R, et al. 25-year physical activity trajectories and development of subclinical coronary artery disease as measured by coronary artery calcium: the coronary artery risk development in young adults (cardia) study. Mayo Clin Proc 2017;92:1660-70. · DOI
  9. Sung K-C, Hong YS, Lee J-Y, et al. Physical activity and the progression of coronary artery calcification. Heart 2021;107:1710-6. · DOI
  10. Imran TF, Patel Y, Ellison RC, et al. Walking and calcified atherosclerotic plaque in the coronary arteries: the National heart, lung, and blood Institute family heart study. Arterioscler Thromb Vasc Biol 2016;36:1272-7. · DOI
  11. Kwaśniewska M, Kostka T, Jegier A, et al. Regular physical activity and cardiovascular biomarkers in prevention of atherosclerosis in men: a 25-year prospective cohort study. BMC Cardiovasc Disord 2016;16:65. · DOI · Paper page
  12. Hamer M, Venuraju SM, Lahiri A, et al. Objectively assessed physical activity, sedentary time, and coronary artery calcification in healthy older adults. Arterioscler Thromb Vasc Biol 2012;32:500-5. · DOI · Paper page
  13. Bertoni AG, Whitt-Glover MC, Chung H, et al. The association between physical activity and subclinical atherosclerosis: the multi-ethnic study of atherosclerosis. Am J Epidemiol 2009;169:444-54. · DOI
  14. Lee DH, Rezende LFM, Ferrari G, et al. Physical activity and all-cause and cause- specific mortality: assessing the impact of reverse causation and measurement error in two large prospective cohorts. Eur J Epidemiol 2021;36:275-85. · DOI
  15. Friedman GD, Cutter GR, Donahue RP, et al. Cardia: study design, recruitment, and some characteristics of the examined subjects. J Clin Epidemiol 1988;41:1105-16. · DOI
  16. Gao (高静伟) J-W, Hao (郝卿鋆) Q-Y, Zhang (张海峰) H-F, et al. Low-Carbohydrate diet score and coronary artery calcium progression: results from the cardia study. Arterioscler Thromb Vasc Biol 2021;41:491-500. · DOI
  17. Jacobs DR, Hahn LP, Haskell WL, et al. Validity and reliability of short physical activity history: cardia and the Minnesota heart health program. J Cardiopulm Rehabil 1989;9:448-59. · DOI
  18. Jacobs DR, Ainsworth BE, Hartman TJ, et al. A simultaneous evaluation of 10 commonly used physical activity questionnaires. Med Sci Sports Exerc 1993;25:10.12 49/00005768-199301000-00012:81-91. · DOI
  19. Gabriel KP, Sidney S, Jacobs DR, et al. Convergent validity of a brief self-reported physical activity questionnaire. Med Sci Sports Exerc 2014;46:1570-7. · DOI
  20. Bild DE, Jacobs DR, Sidney S, et al. Physical activity in young black and white women. The cardia study. Ann Epidemiol 1993;3:636-44. · DOI
  21. Sidney S, Jacobs DR, Haskell WL, et al. Comparison of two methods of assessing physical activity in the coronary artery risk development in young adults (cardia) study. Am J Epidemiol 1991;133:1231-45. · DOI
  22. Pereira MA, FitzerGerald SJ, Gregg EW, et al. A collection of physical activity questionnaires for health-related research. Med Sci Sports Exerc 1997;29:9243481:S1-205.
  23. Hankinson AL, Daviglus ML, Bouchard C, et al. Maintaining a high physical activity level over 20 years and weight gain. JAMA 2010;304:2603-10. · DOI
  24. Carr JJ, Nelson JC, Wong ND, et al. Calcified coronary artery plaque measurement with cardiac CT in population-based studies: standardized protocol of multi-ethnic study of atherosclerosis (MESA) and coronary artery risk development in young adults (cardia) study. Radiology 2005;234:35-43. · DOI
  25. Mao SS, Pal RS, McKay CR, et al. Comparison of coronary artery calcium scores between electron beam computed tomography and 64-multidetector computed tomographic scanner. J Comput Assist Tomogr 2009;33:175-8. · DOI
  26. Agatston AS, Janowitz WR, Hildner FJ, et al. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 1990;15:827-32. · DOI · Paper page
  27. Okwuosa TM, Greenland P, Burke GL, et al. Prediction of coronary artery calcium progression in individuals with low Framingham risk score: the multi-ethnic study of atherosclerosis. JACC Cardiovasc Imaging 2012;5:144-53. · DOI
  28. Pettee Gabriel K, Whitaker KM, Duprez D, et al. Clinical importance of non- participation in a maximal graded exercise test on risk of non-fatal and fatal cardiovascular events and all-cause mortality: cardia study. Prev Med 2018;106:137-44. · DOI
  29. Yano Y, Reis JP, Colangelo LA, et al. Association of blood pressure classification in young adults using the 2017 American College of Cardiology/American heart association blood pressure guideline with cardiovascular events later in life. JAMA 2018;320:1774-82. · DOI
  30. Meyer KA, Benton TZ, Bennett BJ, et al. Microbiota-Dependent metabolite trimethylamine N-oxide and coronary artery calcium in the coronary artery risk development in young adults study (cardia). J Am Heart Assoc 2016;5:e003970. · DOI
  31. Nagin DS, Odgers CL. Group-Based trajectory modeling in clinical research. Annu Rev Clin Psychol 2010;6:109-38. · DOI
  32. Möhlenkamp S, Lehmann N, Breuckmann F, et al. Running: the risk of coronary events : Prevalence and prognostic relevance of coronary atherosclerosis in marathon runners. Eur Heart J 2008;29:1903-10. · DOI · Paper page
  33. DeFina LF, Radford NB, Barlow CE, et al. Association of all-cause and cardiovascular mortality with high levels of physical activity and concurrent coronary artery calcification. JAMA Cardiol 2019;4:174-81. · DOI · Paper page
  34. Parry-Williams G, Gati S, Sharma S. The heart of the ageing endurance athlete: the role of chronic coronary stress. Eur Heart J 2021;42:2737-44. on July 13, 2023 by guest. Protected by copyright. http://bjsm.bmj.com/ Br J Sports Med: first published as 10.1136/bjsports-2021-105092 on 14 March 2022. Downloaded from Original research · DOI
  35. Wu M, Rementer C, Giachelli CM. Vascular calcification: an update on mechanisms and challenges in treatment. Calcif Tissue Int 2013;93:365-73. · DOI
  36. Blond K, Brinkløv CF, Ried-Larsen M, et al. Association of high amounts of physical activity with mortality risk: a systematic review and meta-analysis. Br J Sports Med 2020;54:1195-201. · DOI · Paper page
  37. Arem H, Moore SC, Patel A, et al. Leisure time physical activity and mortality: a detailed pooled analysis of the dose-response relationship. JAMA Intern Med 2015;175:959-67. · DOI · Paper page
  38. Paluch AE, Gabriel KP, Fulton JE, et al. Steps per day and all-cause mortality in middle- aged adults in the coronary artery risk development in young adults study. JAMA Netw Open 2021;4:e2124516. · DOI · Paper page
  39. Mok A, Khaw K-T, Luben R, et al. Physical activity trajectories and mortality: population based cohort study. BMJ 2019;365:l2323. · DOI
  40. Kontro TK, Sarna S, Kaprio J, et al. Mortality and health-related habits in 900 Finnish former elite athletes and their brothers. Br J Sports Med 2018;52:89-95. · DOI
  41. Merghani A, Maestrini V, Rosmini S, et al. Prevalence of subclinical coronary artery disease in masters endurance athletes with a low atherosclerotic risk profile. Circulation 2017;136:126-37. · DOI · Paper page
  42. Criqui MH, Denenberg JO, Ix JH, et al. Calcium density of coronary artery plaque and risk of incident cardiovascular events. JAMA 2014;311:271-8. · DOI · Paper page
  43. Nerlekar N, Ha FJ, Cheshire C, et al. Computed tomographic coronary angiography- derived plaque characteristics predict major adverse cardiovascular events: a systematic review and meta-analysis. Circ Cardiovasc Imaging 2018;11:e006973. · DOI
  44. Puri R, Nicholls SJ, Shao M, et al. Impact of statins on serial coronary calcification during atheroma progression and regression. J Am Coll Cardiol 2015;65:1273-82. · DOI · Paper page
  45. Lechner K, Halle M, Scherr J, et al. Exercise recommendations in athletes with coronary artery calcification. Eur J Prev Cardiol 2020;27:882-4. · DOI
  46. Cheong BYC, Wilson JM, Spann SJ, et al. Coronary artery calcium scoring: an evidence-based guide for primary care physicians. J Intern Med 2021;289:309-24. · DOI
  47. Whitaker KM, Xiao Q, Pettee Gabriel K, et al. Perceived and objective characteristics of the neighborhood environment are associated with accelerometer-measured sedentary time and physical activity, the cardia study. Prev Med 2019;123:242-9. · DOI
  48. Baecke JA, Burema J, Frijters JE. A short questionnaire for the measurement of habitual physical activity in epidemiological studies. Am J Clin Nutr 1982;36:936-42. · DOI

Cited by

Sorted by citations

Authors
Gao, J.-W., Hao, Q.-Y., Lu, L.-Y., Han, J.-J., Huang, F.-F., Vuitton, D. A., Wang, J.-F., Zhang, S.-L., & Liu, P.-M.
Affiliations
  • Sun Yat-sen University (CN)
  • Université Bourgogne Franche-Comté (FR)
Corresponding author
Liu, Pin-Ming
ORCID
Venue
British Journal of Sports Medicine
Publisher
BMJ
Published
2022-03-14
Volume
56
Issue
15
Pages
854-861
ISSN
  • 0306-3674 (ISSN-L)
  • 1473-0480
DOI
10.1136/bjsports-2021-105092
OpenAlex
W4221048103
Cited by
25
References
7
Citations by year
2026: 4 · 2025: 6 · 2024: 7 · 2023: 5 · 2022: 3
FWCI
3.27
Type
journal article
Language
en
Open access
Locations
  • British Journal of Sports Medicine (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Natural Science Foundation of China (81870315, 81900379, 81970683, 82170457)
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
physical activity trajectories, coronary artery calcium progression, cardiovascular disease incidence, long-term physical activity, physical activity guidelines, latent class analysis, CARDIA study, young adults, cardiovascular risk
MeSH terms
Adult, Calcium, Cardiovascular Diseases, Coronary Artery Disease, Female, Humans, Male, Risk Factors, Exercise, Risk Assessment, Young Adult

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review