High-Volume Physical Activity and Clinical Coronary Artery Disease Outcomes: Findings From the Cooper Center Longitudinal Study.
Level 3 - non-randomized controlled study
Non-randomized longitudinal cohort study with long-term follow-up
PubMed 40255152 · doi:10.1161/CIRCULATIONAHA.124.070335
What was done
Researchers linked data from 26,724 participants (mean age 54 years; 28% women) in the Cooper Center Longitudinal Study (1987-2018) to Medicare claims files. Physical activity (PA) volume was categorized from self-reports into <500, 500-1499, 1500-2999, and >=3000 MET-minutes per week. Subclinical coronary artery disease was measured using computed tomography for coronary artery calcium (CAC). Multivariable-adjusted proportional hazards illness-death models assessed associations between PA volume, CAC, composite CAD events (acute myocardial infarction and revascularization), and all-cause mortality over a mean follow-up of 20.5 years.
What was found
During 20.5 years of mean follow-up, there were 811 acute myocardial infarctions, 1,636 composite CAD events, and 2,857 deaths without CAD. Compared with <500 MET-minutes per week: - Lowest risk for acute myocardial infarction occurred at intermediate PA: 500-1499 MET-min/week (HR, 0.77 [95% CI, 0.65-0.91]) and 1500-2499 MET-min/week (HR, 0.78 [95% CI, 0.63-0.95]). - High-volume PA (>=3000 MET-min/week) showed no significant association with acute myocardial infarction risk (HR, 0.95 [95% CI, 0.72-1.25]). - High-volume PA had the lowest mortality risk (HR, 0.71 [95% CI, 0.60-0.83]). - CAC was associated with composite CAD risk across all PA tiers, including >=3000 MET-min/week (HR, 1.29 [95% CI, 1.16-1.44]; P <0.001; P interaction = 0.969).
Why it matters
High-volume exercise provides substantial all-cause mortality benefits without increasing clinical CAD events, though coronary artery calcium remains an active risk marker regardless of physical activity volume.
Limits
Physical activity was assessed via self-report rather than objective trackers. Outcomes were defined via Medicare claims rather than adjudicated clinical records, and the cohort had a relatively low proportion of women (28%).
Cited by
- context A Cooper Clinic analysis of individuals performing more than 10,000 MET-minutes of exercise per week found zero cardiovascular deaths and no increase in overall mortality.