The association between physical activity and both incident coronary artery calcification and ankle brachial index progression: The Multi-Ethnic Study of Atherosclerosis
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.
References (40)
- et al.
The effect of novel cardiovascular risk factors on the ethnic-specific odds for peripheral arterial disease in the Multi-Ethnic Study of Atherosclerosis (MESA)
J Am Coll Cardiol
(2006) - et al.
Associations of borderline and low normal ankle-brachial index values with functional decline at 5-year follow-up: the WALCS (Walking and Leg Circulation Study)
J Am Coll Cardiol
(2009) - et al.
Physical activity, coronary artery calcium, and bone mineral density in elderly men and women: a preliminary investigation
Metabolism
(2008) - et al.
Cardiorespiratory fitness and coronary artery calcification in young adults: the CARDIA Study
Atherosclerosis
(2009) - et al.
Progression of peripheral arterial disease predicts cardiovascular disease morbidity and mortality
J Am Coll Cardiol
(2008) - et al.
Relation of degree of physical activity to coronary artery calcium score in asymptomatic individuals with multiple metabolic risk factors
Am J Cardiol
(2004) - et al.
Walking decreased risk of cardiovascular disease mortality in older adults with diabetes
J Clin Epidemiol
(2007) - et al.
Progression of coronary calcium and incident coronary heart disease events: MESA (Multi-Ethnic Study of Atherosclerosis)
J Am Coll Cardiol
(2013) - et al.
The ankle-brachial index and incident cardiovascular events in the MESA (Multi-Ethnic Study of Atherosclerosis)
J Am Coll Cardiol
(2010) - et al.
Prevalence and prognostic impact of subclinical cardiovascular disease in individuals with the metabolic syndrome and diabetes
Diabetes
(2007)
The association between physical activity and subclinical atherosclerosis: the Multi-Ethnic Study of Atherosclerosis
Am J Epidemiol
Intermittent claudication. Current results of nonoperative management
Arch Surg
Quantitative and qualitative progression of peripheral arterial disease by non-invasive testing
Vasc Med
Decreased ankle/brachial indices in relation to morbidity and mortality in patients with peripheral arterial disease
Vasc Med
Ankle brachial index combined with Framingham risk score to predict cardiovascular events and mortality: a meta-analysis
J Am Med Assoc
The relationship between ankle-brachial index and leisure-time physical activity in patients with intermittent claudication
Angiology
Associations among walking performance, physical activity, and subclinical cardiovascular disease
Prev Cardiol
Physical activity and the presence and extent of calcified coronary atherosclerosis
Med Sci Sports Exerc
Leisure time sedentary behavior, occupational/domestic physical activity, and metabolic syndrome in U.S. men and women
Metab Syndr Relat Disord
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These authors contributed equally and are co-first authors.