Elsevier

Atherosclerosis

Volume 230, Issue 2, October 2013, Pages 278-283
Atherosclerosis

The association between physical activity and both incident coronary artery calcification and ankle brachial index progression: The Multi-Ethnic Study of Atherosclerosis

https://doi.org/10.1016/j.atherosclerosis.2013.07.045Get rights and content

Highlights

  • Exercise is likely misclassified, so associations may be underestimated.

  • There is a significant association between sedentary behavior and CAC progression.

  • Intentional exercise was protective against incident peripheral artery disease.

Abstract

Objective

Both coronary artery calcification (CAC) and the ankle brachial index (ABI) are measures of subclinical atherosclerotic disease. The influence of physical activity on the longitudinal change in these measures remains unclear. To assess this relation we examined the association between these measures and self-reported physical activity in the Multi-Ethnic Study of Atherosclerosis (MESA).

Methods

At baseline, the MESA participants were free of clinically evident cardiovascular disease. We included all participants with an ABI between 0.90 and 1.40 (n = 5656). Predictor variables were based on self-reported measures with physical activity being assessed using the Typical Week Physical Activity Survey from which metabolic equivalent-minutes/week of activity were calculated. We focused on physical activity intensity, intentional exercise, sedentary behavior, and conditioning. Incident peripheral artery disease (PAD) was defined as the progression of ABI to values below 0.90 (given the baseline range of 0.90–1.40). Incident CAC was defined as a CAC score >0 Agatston units upon follow up with a baseline score of 0 Agatston units.

Results

Mean age of participants was 61 years, 53% were female, and mean body mass index was 28 kg/m2. After adjusting for traditional cardiovascular risk factors and socioeconomic factors, intentional exercise was protective for incident peripheral artery disease (Relative Risk (RR) = 0.85, 95% Confidence Interval (CI): 0.74–0.98). After adjusting for traditional cardiovascular risk factors and socioeconomic factors, there was a significant association between vigorous PA and incident CAC (RR = 0.97, 95% CI: 0.94–1.00). There was also a significant association between sedentary behavior and increased amount of CAC among participants with CAC at baseline (Δlog (Agatston Units + 25) = 0.027, 95% CI 0.002, 0.052).

Conclusions

These data suggest that there is an association between physical activity/sedentary behavior and the progression of two different measures of subclinical atherosclerotic disease.

Introduction

Both coronary artery calcification (CAC) and the ankle brachial index (ABI) are measures of subclinical cardiovascular disease (CVD) [1], [2]. From a prevention perspective, it is important to monitor these subclinical CVD measures and determine which risk factors may contribute to their changes. In this regard, the direct effects of physical activity (PA) on the development or progression of subclinical atherosclerosis are not well established [3], [4].

The ABI is used to detect peripheral artery disease (PAD), with a value <0.90 being indicative of significant flow limiting atherosclerotic disease in the lower extremity [5], which can lead to mobility loss [6] and mortality [7], [8]. In patients with intermittent claudication, a decline to a lower ABI has been linked to decreased participation in moderate and vigorous PA [9]. However, it is unknown whether a population free of baseline CVD would show a similar association.

CAC is a measure of atherosclerotic plaque evolution and provides an excellent marker of coronary artery disease. However, there are inconsistencies in the literature related to the association between PA and CAC. Prior research suggests that chronic exercise attenuates the presence and extent of CAC [10], while slower walking time is associated with more CAC [2], [11] and higher levels of cardio-respiratory fitness at a particular age or age range? are associated with a lower risk of having CAC 15 years later [12]. Conversely, other studies have indicated that high intensity PA [13] and/or intentional exercise are unrelated to CAC [2]. To our knowledge, no studies have evaluated different types of PA and changes in CAC over follow-up.

It is important to determine what type and how much activity is most effective at reducing or preventing subclinical CVD. Additionally, since sedentary behaviors are significant CVD mortality predictors [14] and are associated with higher odds of metabolic syndrome and individual CVD risk factors [15], determining how sedentary behaviors influence both prevalent and incident subclinical CVD is also relevant to prevention. As such, the aim of this study was to determine the associations between different types of PA and the incidence and progression of both CAC and the ABI in the Multi-Ethnic Study of Atherosclerosis.

Section snippets

Study design

The Multi-Ethnic Study of Atherosclerosis (MESA) is a population-based sample of 6814 men and women from 4 ethnic groups. Details regarding design, recruitment, and objectives of MESA have been published previously [16]. Briefly, eligible MESA participants were defined as persons living within the defined geographic boundaries of each of the six field centers (Baltimore, MD; Chicago, IL; Forsyth County, NC; Los Angeles County, CA; northern Manhattan, NY; and St. Paul, MN) who were aged 45–84

Results

General characteristics of the study population are presented in Table 1. Data were available for 5656 participants. Since their PAD status was uncertain due to the presence of stiff arteries, 50 participants who progressed to a higher ABI were not included in Table 1. The mean age was approximately 61 years and 47% were male while 41% Non-Hispanic White, 12% Asian, 26% African American, and 21% Hispanic. The average BMI was 28 kg/m [2]. At baseline, approximately 33% had dyslipidemia, 11% had

Discussion

To our knowledge, the associations between PA and progression of either CAC or the ABI have not been previously investigated. Our results suggest that when one is participating in intentional exercise, it protects against incident PAD. Sensitivity analysis revealed that results were similar even after excluding patients with baseline exercise calf pain. These data suggest that any activity reduction secondary to leg pain did not bias the relationship between intentional exercise and incident

Sources of funding

Dr. Jensky is postdoctoral fellow supported by the National Heart Lung and Blood Institute as a T32 Cardiovascular Epidemiology Fellow (T32 HL079891). Dr Delaney was supported on R01HL103729 for this work.

Disclosures

No.

Acknowledgments

The research reported in this article was supported by contracts N01-HC95159 through N01-HC-95169 from the National Heart Lung and Blood Institute. Additional research support was provided through National Heart Lung and Blood Institute (T32 HL079891). The authors thank the other investigators and the staff of the MESA study for their valuable contributions. A full list of participating MESA investigators and institutions can be found at http://www.mesa-nhlbi.org.

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    These authors contributed equally and are co-first authors.

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