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Published on: August 28, 2018
Cardiorespiratory fitness and coronary artery calcification in women
Laura DeFina1, Nina Radford2, David Leonard1
1The Cooper Institute, 12330 Preston Road, Dallas, TX 75230, USA.
Insights
Higher cardiorespiratory fitness (fitness) is linked to better heart health. However, this study found that fitness does not independently reduce coronary artery calcification in women after accounting for traditional risk factors.
Area of Science:
- Cardiovascular disease research
- Exercise physiology
- Preventive cardiology
Background:
- Cardiorespiratory fitness (fitness) is inversely associated with coronary heart disease (CHD) morbidity and mortality.
- The precise cardioprotective mechanisms of fitness remain incompletely understood.
- Investigating fitness's impact on subclinical atherosclerosis is crucial for understanding CHD prevention.
Purpose of the Study:
- To evaluate the relationship between cardiorespiratory fitness and coronary artery calcification (CAC) in a large cohort of healthy women.
- To determine if fitness is an independent predictor of reduced atherosclerotic burden.
- To explore potential cardioprotective pathways of fitness beyond traditional risk factors.
Main Methods:
- Utilized data from 5341 women (ages 40-90) with maximal treadmill exercise testing and coronary artery calcium (CAC) scanning.
- Assessed fitness using METs derived from treadmill performance; characterized CAC dichotomously (CAC=0 vs. CAC>0; CAC<100 vs. CAC≥100).
- Employed multivariable logistic regression to analyze the association between fitness and CAC, adjusting for confounding variables.
Main Results:
- Prevalence of detectable CAC was 19.9%, and CAC≥100 was 6.8% in the cohort.
- Univariable analysis indicated a modest inverse relationship between higher fitness and lower CAC prevalence (p-trend=0.006).
- Multivariable analysis revealed this association was attenuated by age and not statistically significant after adjusting for traditional cardiovascular risk factors.
Conclusions:
- The cardioprotective effects of cardiorespiratory fitness do not appear to be mediated through an independent impact on the development of calcified coronary atherosclerosis.
- Findings suggest that the benefits of fitness on coronary atherosclerosis are largely explained by its association with traditional cardiovascular risk factors.
- Further research is needed to elucidate the specific mechanisms underlying fitness's role in cardiovascular health.
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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