Association of All-Cause and Cardiovascular Mortality With High Levels of Physical Activity and Concurrent Coronary Artery Calcification.
Level 3 - non-randomized controlled study
Prospective observational cohort study
PubMed 30698608 · doi:10.1001/jamacardio.2018.4628
What was done
The Cooper Center Longitudinal Study prospectively evaluated 21,758 generally healthy men without baseline cardiovascular disease who underwent coronary artery calcification (CAC) scanning and reported physical activity between 1998 and 2013. Physical activity was categorized into less than 1500 (n = 16,447), 1500 to 2999 (n = 3750), and 3000 or more (n = 1561) MET-minutes/week. CAC was categorized as less than 100 AU (n = 16,444) or 100 AU or greater (n = 5314). All-cause and cardiovascular disease (CVD) mortality were tracked via the National Death Index Plus through 2014.
What was found
Over a mean follow-up of 10.4 years, 759 all-cause and 180 CVD deaths occurred. Men reporting at least 3000 MET-min/wk were more likely to have CAC of at least 100 AU compared to less active men (relative risk, 1.11; 95% CI, 1.03-1.20). In men with CAC less than 100 AU, physical activity of at least 3000 MET-min/wk was associated with lower all-cause mortality compared with less than 1500 MET-min/wk (hazard ratio [HR], 0.52; 95% CI, 0.29-0.91). In men with CAC of 100 AU or greater, physical activity of at least 3000 MET-min/wk was not associated with increased all-cause mortality compared with less than 1500 MET-min/wk (HR, 0.77; 95% CI, 0.52-1.15). In the least active men, CAC of at least 100 AU was associated with higher CVD mortality compared with CAC under 100 AU (HR, 1.93; 95% CI, 1.34-2.78).
Why it matters
These findings suggest that high-volume exercise is not associated with elevated mortality risk, even when accompanied by substantial coronary artery calcification.
Limits
The study included only men attending a single preventive medicine clinic, limiting generalizability to women and broader populations. Physical activity was self-reported at baseline, and few CVD deaths occurred in the highest physical activity category (n = 10), limiting statistical power for subgroup mortality outcomes.
Cited by
- context In Laura DeFina's 2019 JAMA study of 25,000 Cooper Clinic patients, 75% of participants had coronary artery calcium scores below 100, and among them, high physical activity was associated with a 50% reduction in cardiovascular events with no difference in calcium levels.
- supports In the Cooper Clinic study, high-volume exercisers had an approximately 11% increased risk of having a coronary artery calcium score over 100, but among those with scores over 100, they experienced a 25% reduction in cardiovascular events compared to sedentary individuals.