Physical Activity and Incident Cardiovascular Disease in Women: Is the Relation Modified by Level of Global Cardiovascular Risk?
Open accessAbstract
Background: The inverse association between physical activity and cardiovascular disease ( CVD ) is well‐ established and has previously been shown in people with and without single CVD risk factors. We examined whether level of global cardiovascular risk, on the basis of the pooled cohort equation or Reynolds risk score, which include multiple risk factors, modified the physical activity– CVD association. Methods and Results: Participants in the prospective WHS (Women's Health Study; n=27 536) reported their leisure‐time physical activity at study entry (1992–1995) and during follow‐up through 2013. Participants were divided into 10‐year cardiovascular risk groups on the basis of the pooled cohort equation and Reynolds risk score. The primary outcome was incident total CVD . The CVD hazard ratio for active (≥500 kcal/wk of physical activity) compared with inactive (<500 kcal/wk) individuals was 0.73 (95% confidence interval, 0.66–0.80) in multivariable models. This association was not modified by level of cardiovascular risk; physical activity was inversely associated with CVD within all pooled cohort equation and Reynolds risk score groups ( P =0.17 and P =0.66 for interaction, respectively). When the joint association of physical activity and level of cardiovascular risk was examined, women with higher risk on the basis of either the pooled cohort equation or Reynolds risk score had higher CVD rates compared with those at low risk, regardless of physical activity. However, among women at both high and low risk, being physically active was associated with lower risk of CVD events. Conclusions: In this large prospective cohort of women, level of global cardiovascular risk did not modify the inverse association between leisure‐time physical activity and incident CVD . Thus, promoting physical activity is important in women at both low and high cardiovascular risk.
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Seven studies (37%) demonstrated no evidence for reduced risk of incident ischemic stroke associated with physical activity in women.
“and 7 (37%) demonstrated no evidence for reduced risk of incident stroke associated with physical activity.30,34,37,42,48,56,65”
From Sex Differences in Physical Activity and Incident Stroke: A Systematic Review (2022) · cites this paper as [34]
The Results report a significant association between greater physical activity and lower incident stroke risk in women (HR 0.72; 95% CI, 0.57–0.90). The Discussion likewise says physical activity was significantly inversely associated with incident stroke. The paper does not distinguish ischemic stroke in these passages, but its reported finding contradicts the citing sentence’s attribution of no evidence for reduced incident stroke risk. (LLM, conf=0.90)
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Experimental — accuracy not yet measuredEffect estimates in included studies were mostly relative measures such as hazard ratios or relative risks, though 3 papers reported absolute measures such as population attributable risk percents.
“Effect estimates were mostly relative measures of the association between physical activity and incident stroke (either hazard ratios or relative risks), though 3 papers29,34,47 reported absolute measures of effect such as population attributable risk percents.”
From Sex Differences in Physical Activity and Incident Stroke: A Systematic Review (2022) · cites this paper as [34]
The Methods (Statistical Analysis; page unavailable) say this study estimated hazard ratios for incident stroke, and the Results report those relative estimates. Our copy does not report a population-attributable-risk percentage or establish the citing paper’s count of three studies reporting absolute measures. (LLM, conf=0.88)
Experimental — accuracy not yet measuredFor ischemic stroke, among 10 papers including women and men, 5 (50%) suggested similar effects in women and men.
“For ischemic stroke, of 10 papers including women and men, 5(50%) suggested similar effects in women and men”
From Sex Differences in Physical Activity and Incident Stroke: A Systematic Review (2022) · cites this paper as [34]
The Results (page unavailable) report stroke associations in women, and the Methods describe stroke ascertainment in the women studied. Searches for the ten-paper count and a comparison of effects in women and men found no passage reporting that five of ten papers suggested similar effects. (LLM, conf=0.76)
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Sex Differences in Physical Activity and Incident Stroke: A Systematic Review
Madsen, T. E., Samaei, M., Pikula, A., Yu, A. Y. X., Carcel, C., Millsaps, E., Yalamanchili, R. S., Bencie, N., Dula, A. N., Leppert, M., et al. (2022) · Clinical Therapeutics · doi:10.1016/j.clinthera.2022.02.006 · Cited by 27 · see citing works
Inflammaging and Cardiovascular Risk in Old Women
Moscucci, F., Baratta, F., Bucciarelli, V., Mattioli, A. V., Pinti, M., Zanini, G., Sciomer, S., Gallina, S., Piccirillo, G., & Desideri, G. (2025) · High Blood Pressure & Cardiovascular Prevention · doi:10.1007/s40292-025-00758-1 · Cited by 8 · see citing works
- Authors
- Chomistek, A. K., Cook, N. R., Rimm, E. B., Ridker, P. M., Buring, J. E., & Lee, I. ‐.
- Affiliations
- Indiana University Bloomington (US)
- Brigham and Women's Hospital (US)
- Corresponding author
- Chomistek, Andrea K.
- Venue
- Journal of the American Heart Association
- Published
- 2018-06-19
- Volume
- 7
- Issue
- 12
- ISSN
- 2047-9980 (ISSN-L)
- PMC
- PMC6220541
- OpenAlex
- W2808575447
- Cited by
- 36
- References
- 7
- Citations by year
- 2026: 2 · 2025: 6 · 2024: 6 · 2023: 5 · 2022: 8 · 2021: 3 · 2020: 4 · 2019: 1 · 2018: 1
- FWCI
- 1.55
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc-nd
- Locations
- Journal of the American Heart Association (publishedVersion, cc-by-nc-nd)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Keywords
- physical activity, cardiovascular disease, women, Pooled Cohort Equations, Reynolds Risk Score, cardiovascular risk, leisure-time physical activity, incident cardiovascular events, Women's Health Study, risk factor control
- MeSH terms
- Healthy Lifestyle, Aged, Coronary Disease, Female, Humans, Middle Aged, Prospective Studies, Risk Factors, Sex Factors, Time Factors, United States, Exercise, Incidence, Randomized Controlled Trials as Topic, Walking, Women's Health, Risk Assessment, Stroke, Risk Reduction Behavior, Protective Factors
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