Research Division, The Cooper Institute, Dallas, Texas.
Department of Cardiovascular Medicine, Cooper Clinic, Dallas, Texas.
JAMA Cardiol. 2019 Feb 1;4(2):174-181. doi: 10.1001/jamacardio.2018.4628.
Few data are available to guide clinical recommendations for individuals with high levels of physical activity in the presence of clinically significant coronary artery calcification (CAC).
To assess the association among high levels of physical activity, prevalent CAC, and subsequent mortality risk.
DESIGN, SETTING, AND PARTICIPANTS: The Cooper Center Longitudinal Study is a prospective observational study of patients from the Cooper Clinic, a preventive medicine facility. The present study included participants seen from January 13, 1998, through December 30, 2013, with mortality follow-up through December 31, 2014. A total of 21 758 generally healthy men without prevalent cardiovascular disease (CVD) were included if they reported their physical activity level and underwent CAC scanning. Data were analyzed from September 26, 2017, through May 2, 2018.
Self-reported physical activity was categorized into at least 3000 (n = 1561), 1500 to 2999 (n = 3750), and less than 1500 (n = 16 447) metabolic equivalent of task (MET)-minutes/week (min/wk). The CAC scores were categorized into at least 100 (n = 5314) and less than 100 (n = 16 444) Agatston units (AU).
All-cause and CVD mortality collected from the National Death Index Plus.
Among the 21 758 male participants, baseline mean (SD) age was 51.7 (8.4) years. Men with at least 3000 MET-min/wk were more likely to have prevalent CAC of at least 100 AU (relative risk, 1.11; 95% CI, 1.03-1.20) compared with those accumulating less physical activity. In the group with physical activity of at least 3000 MET-min/wk and CAC of at least 100 AU, mean (SD) CAC level was 807 (1120) AU. After a mean (SD) follow-up of 10.4 (4.3) years, 759 all-cause and 180 CVD deaths occurred, including 40 all-cause and 10 CVD deaths among those with physical activity of at least 3000 MET-min/wk. Men with CAC of less than 100 AU and physical activity of at least 3000 MET-min/wk were about half as likely to die compared with men with less than 1500 MET-min/wk (hazard ratio [HR], 0.52; 95% CI, 0.29-0.91). In the group with CAC of at least 100 AU, men with at least 3000 MET-min/wk did not have a significant increase in all-cause mortality (HR, 0.77; 95% CI, 0.52-1.15) when compared with men with physical activity of less than 1500 MET-min/wk. In the least active men, those with CAC of at least 100 AU were twice as likely to die of CVD compared with those with CAC of less than 100 AU (HR, 1.93; 95% CI, 1.34-2.78).
This study suggests there is evidence that high levels of physical activity (≥3000 MET-min/wk) are associated with prevalent CAC but are not associated with increased all-cause or CVD mortality after a decade of follow-up, even in the presence of clinically significant CAC levels.
在存在临床显著冠状动脉钙化 (CAC) 的情况下，关于高水平体力活动的临床建议，可用的数据很少。
评估高水平体力活动、普遍 CAC 和随后的死亡风险之间的关联。
设计、地点和参与者：库珀中心纵向研究是一项对来自库珀诊所（预防医学设施）的患者进行的前瞻性观察研究。本研究纳入了 1998 年 1 月 13 日至 2013 年 12 月 30 日期间就诊、并通过 2014 年 12 月 31 日进行死亡随访的患者。如果患者报告了他们的体力活动水平并接受了 CAC 扫描，则包括一般健康男性且无现有心血管疾病（CVD）的患者。数据于 2017 年 9 月 26 日至 2018 年 5 月 2 日进行分析。
自我报告的体力活动分为至少 3000（n=1561）、1500 至 2999（n=3750）和少于 1500（n=16447）代谢当量任务（MET）分钟/周（min/wk）。CAC 评分分为至少 100（n=5314）和少于 100（n=16444）Agatston 单位（AU）。
从国家死亡指数加中收集所有原因和心血管疾病死亡率。
在 21758 名男性参与者中，基线平均（SD）年龄为 51.7（8.4）岁。与体力活动较少的参与者相比，至少有 3000MET-min/wk 的男性更有可能出现至少 100 AU 的 CAC（相对风险，1.11；95%CI，1.03-1.20）。在至少有 3000MET-min/wk 体力活动和至少有 100 AU CAC 的组中，平均（SD）CAC 水平为 807（1120）AU。在平均（SD）随访 10.4（4.3）年后，发生了 759 例全因死亡和 180 例心血管疾病死亡，其中 40 例全因死亡和 10 例心血管疾病死亡发生在至少有 3000MET-min/wk 体力活动的患者中。与至少有 1500 MET-min/wk 体力活动的男性相比，CAC 少于 100 AU 且至少有 3000 MET-min/wk 体力活动的男性死亡的可能性降低了约一半（危险比[HR]，0.52；95%CI，0.29-0.91）。在至少有 100 AU CAC 的组中，与至少有 1500 MET-min/wk 体力活动的男性相比，至少有 3000 MET-min/wk 体力活动的男性全因死亡率没有显著增加（HR，0.77；95%CI，0.52-1.15）。在最不活跃的男性中，与 CAC 少于 100 AU 的男性相比，CAC 至少 100 AU 的男性死于心血管疾病的风险增加了一倍（HR，1.93；95%CI，1.34-2.78）。
这项研究表明，有证据表明高水平体力活动（≥3000 MET-min/wk）与普遍 CAC 相关，但在十年随访后，即使存在临床显著 CAC 水平，与全因或心血管疾病死亡率的增加无关。
