Physical Activity, Coronary Artery Calcium, and Cardiovascular Outcomes in the Multi-Ethnic Study of Atherosclerosis (MESA)

Abstract Aims The benefits of physical activity (PA) on cardiovascular disease (CVD) are well known. However, studies suggest PA is associated with coronary artery calcium (CAC), a subclinical marker of CVD. In this study, we evaluated the associations of self-reported recreational and non-recreational PA with CAC composition and incident CVD events. Prior studies suggest high CAC density may be protective for CVD events. Methods and results We evaluated 3393 participants of the Multi-Ethnic Study of Atherosclerosis with prevalent CAC. After adjusting for demographics, the highest quintile of recreational PA was associated with 0.07 (95% confidence interval 0.01–0.13) units greater CAC density but was not associated with CAC volume. In contrast, the highest quintile of non-recreational PA was associated with 0.08 (0.02–0.14) units lower CAC density and a trend toward 0.13 (−0.01 to 0.27) log-units higher CAC volume. There were 520 CVD events over a 13.7-year median follow-up. Recreational PA was associated with lower CVD risk (hazard ratio 0.88, 0.79–0.98, per standard deviation), with an effect size that was not changed with adjustment for CAC composition or across levels of prevalent CAC. Conclusion Recreational PA may be associated with a higher density but not a higher volume of CAC. Non-recreational PA may be associated with lower CAC density, suggesting these forms of PA may not have equivalent associations with this subclinical marker of CVD. While PA may affect the composition of CAC, the associations of PA with CVD risk appear to be independent of CAC.

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Abstract 045: Leisure Time Physical Activity is Associated With Higher Coronary Artery Calcium Density: The Multi-Ethnic Study of Atherosclerosis

Circulation ◽

10.1161/circ.137.suppl_1.045 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Isac C Thomas ◽

Matthew Allison ◽

Nketi Forbang ◽

Michelle Takemoto ◽

Erin Michos ◽

...

Keyword(s):

Physical Activity ◽

Risk Factors ◽

Coronary Artery ◽

Coronary Artery Calcium ◽

Leisure Time ◽

Leisure Time Physical Activity ◽

Statistical Significance ◽

Unexpected Finding ◽

Cvd Risk ◽

Ethnic Study

Introduction: Leisure-time physical activity (LTPA) has favorable effects on many risk factors for cardiovascular disease (CVD). Paradoxically, LTPA has also been associated with higher amounts of coronary artery calcium (CAC) in athletes. Recently, a higher density of CAC was shown to significantly mitigate the risk of CVD associated with a given volume of CAC. The effects of LTPA and non-LTPA on the density and volume components of CAC among individuals with calcified coronary atherosclerosis are unknown. Methods: We evaluated 3,398 participants from the Multi-Ethnic Study of Atherosclerosis with prevalent CAC (50% of cohort). CAC was assessed via cardiac computed tomography, while physical activity was assessed via questionnaire and categorized by quintiles of moderate and vigorous LTPA (e.g. exercise) and non-LTPA (e.g. work). Multiple linear regression with mutual adjustment for LTPA, non-LTPA, demographics, and CVD risk factors was performed. Results: Mean age of the sample was 66 years, 58% were male, 44% were Caucasian, 24% were African-American, 20% were Hispanic, and 12% were Chinese-American. Compared to the lower four quintiles, LTPA above the threshold of 2567 MET-minutes/week (quintile 5) was associated with 0.057 (0.008, 0.105) higher CAC density-units after full adjustment. LTPA at any level was not associated with CAC volume. Conversely, non-LTPA was associated with both lower CAC density and higher CAC volume in a stepwise fashion, with the highest quintile meeting statistical significance for both (see Table). Conclusions: The highest quintile of LTPA was associated with higher CAC density but not higher CAC volume, suggesting a possible explanation for high CAC scores in athletes with favorable CVD risk factor profiles. Non-LTPA was associated with a less favorable CAC composition after adjustment for LTPA, an unexpected finding that merits further investigation.

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Abstract 14662: Relationships Between Physical Activity, Coronary Artery Calcium, and Cardiovascular Outcomes in the Multi-Ethnic Study of Atherosclerosis: MESA

Circulation ◽

10.1161/circ.142.suppl_3.14662 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Charles A German ◽

Jason Fanning ◽

Matthew J Singleton ◽

Michael D Shapiro ◽

Peter H Brubaker ◽

...

Keyword(s):

Physical Activity ◽

Coronary Artery ◽

Coronary Artery Calcium ◽

Adverse Outcomes ◽

Atherosclerotic Cardiovascular Disease ◽

Ethnic Study ◽

Increased Risk ◽

All Cause Mortality ◽

Cox Proportional Hazard Regression ◽

Reduced Risk

Introduction: Physical activity is associated with decreased rates of atherosclerotic cardiovascular disease (ASCVD) and mortality. However, high levels of physical activity (PA) have paradoxically been linked with elevated levels of coronary artery calcium (CAC). It remains unclear whether high levels of physical activity in the presence of high CAC are associated with adverse outcomes in a diverse, multi-ethnic population. Hypothesis: We hypothesized that high compared to low levels of PA are associated with a reduction in incident ASCVD and all-cause mortality, even in the presence of high CAC. Methods: Baseline total PA (MET-min/week) in the Multi-Ethnic Study of Atherosclerosis (MESA), obtained via questionnaire, was divided into quartiles. CAC was dichotomized into low (CAC <100 Agatston Units (AU)) and high (CAC ≥100 AU) categories. Outcomes of interest included ASCVD and all-cause mortality. Cox proportional hazard regression analysis was used to assess associations between PA, ASCVD, and all-cause mortality among low and high CAC groups. Results: Among the 6,814 participants included in this study, the average age was 62 years, 53% were female, and 38% were non-Hispanic white. In participants with CAC <100 AU and PA in the highest quartile, we observed a significant reduction in ASCVD and all-cause mortality compared with participants in the lowest PA quartile (Table1). In participants with CAC ≥100 AU and PA in the highest quartile, we observed a significant reduction in all-cause mortality, but no difference in the risk of ASCVD compared with participants in the lowest PA quartile. Conclusions: Our study suggests that high levels of PA are associated with a reduced risk of ASCVD and all-cause mortality among individuals with low CAC, and a reduced risk of all-cause mortality among individuals with high CAC. There was no evidence to suggest an increased risk of ASCVD from high levels of PA in individuals with high CAC.

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Faculty Opinions recommendation of Distribution of coronary artery calcium scores by Framingham 10-year risk strata in the MESA (Multi-Ethnic Study of Atherosclerosis) potential implications for coronary risk assessment.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.11870958.12972056 ◽

2011 ◽

Author(s):

Christopher Kramer

Keyword(s):

Risk Assessment ◽

Coronary Artery ◽

Coronary Artery Calcium ◽

Coronary Risk ◽

Ethnic Study

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222: Lipoproteins in the Prediction of Coronary Artery Calcium (CAC) as Modified by Age in the Multi-Ethnic Study of Atherosclerosis (MESA)

Journal of Clinical Lipidology ◽

10.1016/j.jacl.2008.04.039 ◽

2008 ◽

Vol 2 (3) ◽

pp. 223

Author(s):

Pathmaja Paramsothy ◽

Gregory L. Burke ◽

Ronit Katz ◽

Kevin D. O'Brien ◽

David S. Owens ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Artery Calcium ◽

Ethnic Study

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Abstract P104: Higher Leptin Levels Are Associated With Increased Odds Of Coronary Artery Calcium Progression: The Multi-ethnic Study Of Atherosclerosis

Circulation ◽

10.1161/circ.143.suppl_1.p104 ◽

2021 ◽

Vol 143 (Suppl_1) ◽

Author(s):

Bhavya Varma ◽

Oluseye Ogunmoroti ◽

Chiadi Ndumele ◽

Di Zhao ◽

Moyses Szklo ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Artery Calcium ◽

Cardiac Ct ◽

Subclinical Atherosclerosis ◽

Community Dwelling ◽

Ct Scans ◽

Agatston Score ◽

Cvd Risk ◽

Ethnic Study ◽

History Of

Background: Adipokines are secreted by adipose tissue, play a role in cardiometabolic pathways, and have differing associations with cardiovascular disease (CVD). Coronary artery calcium (CAC) and its progression indicate subclinical atherosclerosis and prognosticate CVD risk. However the association of adipokines with CAC progression is not well established. We examined the association of adipokines with the odds of a history of CAC progression in the Multi-Ethnic Study of Atherosclerosis (MESA). Methods: We performed an analysis of 1,904 community dwelling adults free of clinical CVD in MESA. Participants underwent measurement of serum adipokines [leptin, resistin and adiponectin] at visits 2 or 3 (randomly assigned) and a contemporaneous cardiac CT scan at same visit. Participants also had a prior cardiac CT at visit 1, at a median of 2.4 years earlier. On both CTs, CAC was quantified by Agatston score. We defined a history of CAC progression between the CT scans at visit 1 and at visit 2 or 3 as those with >0 Agatston units of change per year (and compared to those with ≤0 units of change per year). We used logistic regression to examine the odds of having a history of CAC progression by adipokine tertiles using progressively adjusted models. Results: The mean participant age was 65 (10) years; 50% were women, 40% White, 13% Chinese, 21% Black and 26% Hispanic. The prevalences of CAC at visits 1 and 2/3 were 49% and 58%, respectively. There were 1,001 (53%) who had CAC progression between the 2 CT scans. In demographic-adjusted models (model 1, Table), higher leptin and lower adiponectin were associated with increased odds of prior CAC progression. In models fully adjusted for BMI and other CVD risk factors (model 3), only the highest tertile of leptin remained associated with a greater odds of prior CAC progression [OR 1.55 (95% CI 1.04, 2.30)]. Conclusions: Higher leptin levels were independently associated with a history of CAC progression. Atherosclerosis progression may be one mechanism through which leptin confers increased CVD risk

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