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Cardiorespiratory Fitness and Coronary Artery Calcification in a Primary Prevention Population

Cindy A Kermott1, Darrell R Schroeder2, Stephen L Kopecky3

  • 1Division of Preventive, Occupational, and Aerospace Medicine, Mayo Clinic, Rochester, MN.

Mayo Clinic Proceedings. Innovations, Quality & Outcomes
|June 14, 2019
PubMed

Insights

Cardiorespiratory fitness (CRF) in men shows a complex relationship with coronary artery disease. Average CRF may be protective, but maximal CRF is linked to increased plaque burden, even with optimized risk factors.

Area of Science:

  • Cardiology
  • Preventive Medicine
  • Exercise Physiology

Background:

  • Cardiorespiratory fitness (CRF) is a key indicator of cardiovascular health.
  • The relationship between CRF and coronary artery disease (CAD) plaque burden requires further elucidation.
  • Understanding this relationship is crucial for developing effective preventive strategies.

Purpose of the Study:

  • To investigate the association between cardiorespiratory fitness (CRF) and coronary artery disease (CAD) plaque burden in middle-aged men.
  • To determine if higher levels of CRF are protective against or contributory to atherosclerosis.
  • To analyze the impact of CRF on lifelong plaque burden as measured by coronary artery calcium (CAC) scores.

Main Methods:

  • Retrospective analysis of 2946 working middle-aged men from the Mayo Clinic Executive Health Program (1995-2008).
  • Assessment of coronary artery calcium (CAC) for lifelong plaque burden.
  • Exercise treadmill testing to categorize functional aerobic capacity (FAC) into four levels of CRF.
  • Consideration of known cardiovascular disease risk factors, including family history.

Main Results:

  • Cardiovascular risk factor profiles generally improved with increasing CRF levels.
  • The above-average CRF group (third of four levels) showed consistently lower CAC scores compared to other levels.
  • A U-shaped distribution was observed, with the highest CRF level showing significantly increased plaque burden compared to the above-average group, despite optimal risk factor profiles.

Conclusions:

  • For men, maximal cardiorespiratory fitness (CRF) is associated with increased atherosclerosis, as indicated by CAC scores.
  • Average-to-moderate CRF appears to be cardioprotective, irrespective of age or other conventional cardiac risk factors.
  • These findings suggest a non-linear relationship between CRF and CAD plaque burden, highlighting the importance of optimal, rather than maximal, fitness levels for cardiovascular health.
Abstract

Keywords:
BMI, body mass indexCAC, coronary artery calciumCAD, coronary artery diseaseCRF, cardiorespiratory fitnessCT, computed tomographyFAC, functional aerobic capacityIQR, interquartile rangeMET, metabolic equivalent

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