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Linked to calcium deposits in the coronary arteries, used to measure the risk of cardiovascular disease But the results do not outweigh the many health benefits of exercise, the researchers point out.
Paradoxically, physical activity can accelerate the build-up of calcium deposits (plaque) in the coronary arteries, the amount of which is used to assess future risk of cardiovascular disease, according to research published online in the journal Heart.
But the results don’t outweigh the many health benefits of exercise, the researchers point out.
The coronary artery calcium score, or CAC score for short, is used to guide treatment to prevent a heart attack or stroke. Statins are indicated for most people with a CAC score of 100 or higher.
Regular physical activity is associated with a dose-dependent reduction in the risk of obesity, diabetes, heart attack / stroke, and death, among others.
But research shows that despite these important health benefits, very physically active people seem to have high levels of calcium deposits in their coronary arteries. It is therefore not clear whether exercise itself can be associated with calcification (hardening of the arteries).
In an effort to explore this question further, the researchers studied healthy adults who underwent regular comprehensive examinations at two large health centers in Seoul and Suwon, South Korea, between March 2011 and December 2017, in as part of the Kangbuk Samsung Health study.
At each check-up, participants completed a questionnaire, which included questions about medical and family history, lifestyle and level of education. Weight (BMI), blood pressure, and blood lipids were also assessed.
Physical activity was formally categorized at the first exam as inactive, moderately active, or “health enhancing” (intensely) physically active, using a validated questionnaire.
The scans followed the development and / or progression of calcification of the coronary arteries which was then noted (CAC score) over an average period of 3 years.
Some 25,485 people (22,741 men and 2,744 women), aged 30 or more and with at least two CAC scores, were included in the final analysis.
Some 47% (11,920), 38% (9,683) and 15% (3,882) of them were, respectively, inactive, moderately active and intensely physically active, which is equivalent to running 6.5 km / day.
Those who were more physically active tended to be older and less likely to smoke than less physically active participants. They also had lower total cholesterol, higher blood pressure, and existing evidence of calcium deposits in their coronary arteries.
A gradual association between the level of physical activity and the prevalence and progression of coronary artery calcification appeared over time, independent of CAC scores at the start of the surveillance period.
The estimated adjusted mean CAC scores in the three groups at the start of the surveillance period were 9.45, 10.20, and 12.04, respectively.
But higher physical activity was associated with faster progression of CAC scores both in those without calcium deposits and in those who already had a CAC score at the start of the monitoring period.
Compared with those who were inactive, the estimated 5-year adjusted average increases in CAC scores in moderately and intensely active participants were 3.20 and 8.16, respectively, even after accounting for potentially influencing factors, including BMI, blood pressure and blood lipids.
This is an observational study, and as such, cannot establish the cause. The researchers also recognize several limitations of the study, including the lack of an objective assessment of physical activity; and no data on incident heart attacks / strokes or on the density or volume of CACs.
Physical activity can increase coronary atherosclerosis (narrowing of the artery) through mechanical stress and damage to the vascular wall and through the physiological responses it elicits, such as increased blood pressure and parathyroid hormone, they explain. Physical activity can also alter the effect of diet, vitamins and minerals, they suggest.
“The second possibility is that physical activity may increase CAC scores without increasing [cardiovascular disease] risk, ”they write.
“The cardiovascular benefits of physical activity are unquestionable,” they stress, reiterating national guidelines recommending at least 150-300 minutes / week of moderate-intensity physical activity or 75-150 minutes / week of aerobic physical activity. vigorous intensity.
“Patients and physicians, however, should consider that participating in physical activity may accelerate the progression of coronary calcium, possibly due to scarring, stabilization and calcification of the plaque,” they conclude.
In a linked editorial, Drs Gaurav Gulsin and Alastair James Moss, from the Department of Cardiovascular Sciences, University of Leicester, ask: ‘Do these results mean we should stop using coronary artery calcium scores to assess coronary heart disease? “
The study highlights the complexity of interpreting CAC scores in patients who increased their physical activity or started taking statins – also associated with higher scores, they point out.
“Although proponents argue that this is an effective tool for screening for subclinical atherosclerosis in asymptomatic individuals, clinicians should be careful about overusing this test in otherwise healthy individuals. “, They warn.
In a related podcast, Dr Moss explains that uncalcified plaque, which is more unstable and more likely to rupture, may be larger and should be noted to assess a person’s future risk of having a heart attack or heart attack. stroke.
“Maybe the target we need to look for is uncalcified plaque rather than calcified plaque,” he suggests. This was not visible on the scans used in this study.
“Increased rates of coronary artery calcification are observed both in response to effective treatment such as statin therapy and exercise. But it should not necessarily be considered that serial imaging with calcium scans is the best way to accurately assess [cardiovascular disease] risk in these people.
But he reiterates, “Obviously, exercise is one of the best ways to try to control cardiovascular risk in children. [people without symptoms]. “
The references:
“Physical activity and progression of coronary artery calcification” by Ki-Chul Sung, Yun Soo Hong, Jong-Young Lee, Seung-Jae Lee, Yoosoo Chang, Seungho Ryu, Di Zhao, Juhee Cho, Eliseo Guallar and Joao AC Lima , September 20, 2021, Heart.
DOI: 10.1136 / heartjnl-2021-319346
“Coronary artery calcium paradox and physical activity” by Gaurav S Gulsin and Alastair James Moss, September 20, 2021, Heart.
DOI: 10.1136 / heartjnl-2021-319868
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