Physical activity, coronary artery calcium, and cardiovascular outcomes in the Multi-Ethnic Study of Atherosclerosis (MESA)
Open accessAbstract
Introduction: Although the inverse relationship between physical activity (PA) and cardiovascular disease (CVD) is well established, observational studies suggest that very high levels of PA may be harmful. This study sought to understand the relationship between PA, coronary artery calcium (CAC), and cardiovascular outcomes among individuals at different levels of risk. Methods: PA and CAC were assessed in 6777 baseline participants of the Multi-Ethnic Study of Atherosclerosis. Total PA in MET-minutes per week was categorized into quartiles, and CAC was categorized as “low risk” (<100 Agatston units; n = 5180) and “high risk” (≥100 Agatston units; n = 1597). Cox proportional hazard regression analyses and Kaplan–Meier curves were generated to understand relationships between PA and CAC with CVD and all-cause mortality. Results: In low-risk participants in the highest PA quartile, there was a decrease in the adjusted hazard ratio (HR) for CVD (HR, 0.72; 95% confidence interval (CI), 0.56–0.94) and all-cause mortality (HR, 0.69; 95% CI, 0.57–0.84) compared with those in the lowest PA quartile. In high-risk participants in the highest PA quartile, there was a decrease in the adjusted HR for all-cause mortality (HR, 0.59; 95% CI, 0.47–0.74) compared with those in the lowest PA quartile. High PA was not associated with an increased risk of either outcome, regardless of CAC category, sex, or race/ethnicity. Conclusions: Our research suggests that there is no increased risk associated with high levels of PA, even among individuals at high risk of CVD.
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Some studies have shown that endurance exercise reduces the risk for ischaemic events regardless of CAC score, and this reduction is greatest at the higher CAC scores.
“Some studies have shown that endurance exercise reduces the risk for ischaemic events regardless of CAC score, and this reduction is greatest at the higher CAC scores.24,26”
From Lifelong endurance exercise and its relation with coronary atherosclerosis (2023) · cites this paper as [24]
The Results (Overall Relationship Between PA, CAC and Cardiovascular Outcomes) report fewer incident CVD events with higher physical activity only for participants with CAC <100 AU; they state there was no significant association with CVD for participants with CAC ≥100 AU. The Discussion describes the largest risk differences at high CAC in another analysis, but those differences concerned mortality, not ischaemic events. (LLM, conf=0.88)
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Experimental — accuracy not yet measuredCurrent 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 [24]
The Results (Overall Relationship Between PA, CAC and Cardiovascular Outcomes; page not available) report no significant increase in incident cardiovascular disease among participants with high physical activity. However, the study examined a general MESA cohort, not endurance athletes, and its cardiovascular outcome was a composite rather than ischaemic heart disease events specifically. (LLM, conf=0.88)
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- Authors
- GERMAN, C. A., FANNING, J., SINGLETON, M. J., SHAPIRO, M. D., BRUBAKER, P. H., BERTONI, A. G., & YEBOAH, J.
- Affiliations
- University of Chicago (US)
- Wake Forest University (US)
- Wake Forest University Health Sciences (US)
- Venue
- Medicine & Science in Sports & Exercise
- Published
- 2021-12-30
- Volume
- 54
- Issue
- 5
- Pages
- 800-806
- ISSN
- 0195-9131 (ISSN-L)
- 1530-0315
- PMC
- PMC9203864
- OpenAlex
- W4200041536
- Cited by
- 23
- References
- 38
- Citations by year
- 2026: 6 · 2025: 5 · 2024: 5 · 2023: 6 · 2022: 1
- FWCI
- 1.89
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Medicine & Science in Sports & Exercise (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (n01hc95164-17-0-1, UL1TR001420, n01hc95165-34-0-1, n01hc95161-24-0-1, n01hc095169-003, n01hc95166-21-0-1, n01hc95162-31-0-1, n01hc95168-27-0-1, n01hc95160-18-0-1, n01hc095167-000, UL1TR001079, n01hc95163-22-0-1, n01hc95159-40-0-1, UL1TR000040)
- National Heart, Lung, and Blood Institute (N01-HC095169, 75N92020D00001, N01-HC-095165, 75N92020D00006, N01 HC095163, 75N92020D00007, 75N92020D00002, N01-HC-095159, N01 HC095168, N01-HC-095162, N01-HC-095161, 75N92020D00005, HHSN268201500003C, HHSN26820150 0003I, 75N92020D00003, N01 HC095167, N01-HC-095160, N01 HC095166, N01 HC095164, 75N92020D00004)
- National Center for Advancing Translational Sciences
- 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, coronary artery calcium, cardiovascular disease, all-cause mortality, high-intensity physical activity, cardiovascular risk, Agatston units, Multi-Ethnic Study of Atherosclerosis, sex differences, racial and ethnic differences
- MeSH terms
- Calcium, Calcium, Dietary, Cardiovascular Diseases, Coronary Artery Disease, Coronary Vessels, Ethnicity, Humans, Risk Factors, Exercise, Atherosclerosis, Vascular Calcification
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