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Associations of long-term physical activity trajectories with coronary artery calcium progression and cardiovascular disease events: results from the CARDIA study
  1. Jing-Wei Gao1,
  2. Qing-Yun Hao1,
  3. Liu-Yi Lu2,
  4. Jia-Jin Han1,
  5. Fei-Fei Huang1,
  6. Dominique A. Vuitton3,
  7. Jing-Feng Wang1,
  8. Shao-Ling Zhang4,
  9. Pin-Ming Liu1
  1. 1Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
  2. 2Department of Cardiovascular Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
  3. 3Research Unit EA 3181, Université Bourgogne Franche-Comté, 25030 Besançon, France
  4. 4Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
  1. Correspondence to Professor Pin-Ming Liu, Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China; liupm{at}mail.sysu.edu.cn; Professor Shao-Ling Zhang, Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China; zhshaol{at}mail.sysu.edu.cn

Abstract

Objective The study aimed to assess the associations of physical activity (PA) trajectories across a 25-year span with coronary artery calcium (CAC) progression, and subsequent risk of cardiovascular disease (CVD) events.

Methods We included 2497 participants from the Coronary Artery Disease Risk Development in Young Adults study who had computed tomography-assessment of CAC at baseline (year 15: 2000–2001) and follow-up (year 20 or 25) and at least three measures of PA from year 0 to year 25. Long-term PA trajectories were determined by latent class modelling using a validated questionnaire.

Results Among the included participants, 1120 (44.9%) were men, 1418 (56.8%) were white, and the mean (SD) age was 40.4 (3.6) years. We identified three distinct PA trajectories based on PA average levels and change patterns: low (below PA guidelines, n=1332; 53.3%); moderate (meeting and slightly over PA guidelines, n=919; 36.8%) and high (about three times PA guidelines or more, n=246; 9.9%). During a mean (SD) follow-up of 8.9 (2.1) years, 640 (25.6%) participants had CAC progression. Participants in the high PA trajectory group had a higher risk of CAC progression than those in the low PA trajectory group after adjustment for traditional cardiovascular risk factors (HR 1.51; 95% CI 1.18 to 1.94). However, high PA trajectory was not associated with an increased risk of incident CVD events (HR 1.01; 95% CI 0.44 to 2.31) and the incidence of CVD events in participants with CAC progression was similar across all three PA trajectory groups (p=0.736).

Conclusion Long-term PA about three times the guidelines or more is independently associated with CAC progression; however, no additional risk of incident CVD events could be detected.

  • physical activity
  • cardiovascular diseases

Data availability statement

Data are available on reasonable request. Data may be obtained from a third party and are not publicly available. Data may be obtained from a third party and are not publicly available. Data are available upon request and data use agreement with the CARDIA study (https://www.cardia.dopm.uab.edu/).

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Data availability statement

Data are available on reasonable request. Data may be obtained from a third party and are not publicly available. Data may be obtained from a third party and are not publicly available. Data are available upon request and data use agreement with the CARDIA study (https://www.cardia.dopm.uab.edu/).

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Footnotes

  • J-WG and Q-YH contributed equally.

  • Contributors J-WG and P-ML had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. J-WG, Q-YH and P-ML were responsible for the study concept and design. Q-YH, J-WG and J-JH conducted the statistical analysis and interpreted the data. Q-YH and J-WG drafted the manuscript. J-WG, DAV and P-ML contributed to critical revision of the manuscript for important intellectual content. S-LZ and P-ML were responsible for the study supervision. P-ML was the guarantor and responsible for the overall content. All authors approved the final version of the manuscript.

  • Funding This work is supported by grants from National Natural Science Foundation of China (82170457, 81900379, 81870315, 81970683). The CARDIA study is conducted and supported by the National Heart, Lung and Blood Institute in collaboration with the University of Alabama at Birmingham (grants HHSN268201800005I and HHSN268201800007I), Northwestern University (grant HHSN268201800003I), University of Minnesota (grant HHSN268201800006I) and Kaiser Foundation Research Institute (grant HHSN268201800004I), of the USA.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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