Berry Jarett D, Zabad Noor, Kyrouac Douglas, Leonard David, Barlow Carolyn E, Pavlovic Andjelka, Shuval Kerem, Levine Benjamin D, DeFina Laura F
Department of Internal Medicine, University of Texas at Tyler School of Medicine (J.D.B., N.Z.).
Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (J.D.B., D.K., B.D.L.).
Circulation. 2025 May 6;151(18):1299-1308. doi: 10.1161/CIRCULATIONAHA.124.070335. Epub 2025 Apr 21.
High-volume physical activity (PA) is associated with a higher prevalence of subclinical coronary artery disease (CAD). However, the clinical significance of subclinical CAD among high-volume exercisers remains incompletely understood, and the dose-response relationship between high-volume PA and clinical CAD events remains uncertain.
Individual participant data from the Cooper Center Longitudinal Study (1987-2018) were linked to Medicare claims files. PA volume was determined by self-report and categorized as <500, 500 to 1499, 1500 to 2999, and ≥3000 metabolic equivalent of task (MET)-minutes per week. Subclinical CAD (coronary artery calcium [CAC]) was measured by cardiac computed tomography. All other risk factors were measured in the standard fashion. Composite CAD events (acute myocardial infarction and revascularization) and all-cause mortality were determined from Medicare claims files. A multivariable-adjusted proportional hazards illness-death model with random shared frailty was used to estimate the association between PA volume, CAC, and both clinical CAD and death. Heterogeneity in the association between CAC and clinical CAD across levels of PA was determined with multiplicative interaction terms.
We included 26 724 participants (54 years of age; 28% women). Mean exercise volume was 1130 MET-minutes per week, with 1997 (7.5%) reporting ≥3000 MET-minutes per week. After a mean follow-up of 20.5 years, we observed 811 acute myocardial infarction events, 1636 composite CAD events, and 2857 deaths without CAD. Compared with individuals exercising <500 MET-minutes per week, the lowest risk for acute myocardial infarction occurred among individuals with intermediate PA volumes (500-1499 MET-minutes per week: hazard ratio [HR], 0.77 [95% CI, 0.65-0.91]; 1500-2499 MET-minutes per week: HR, 0.78 [95% CI, 0.63-0.95]). There was no association between high-volume PA (>3000 MET-minutes per week) and risk for acute myocardial infarction (HR, 0.95 [95% CI, 0.72-1.25]). In contrast, the lowest risk for death was observed among the high-volume PA group (HR, 0.71 [95% CI, 0.60-0.83]). CAC (on log scale) was associated with a higher risk for composite CAD across all PA categories, including among the high-volume PA subgroup (HR, 1.29 [95% CI, 1.16-1.44]; <0.001; = 0.969).
Compared with low-volume PA, high-volume PA was associated with a lower risk for all-cause mortality but a similar risk for clinical CAD. CAC was associated with an increased risk for clinical CAD regardless of the volume of PA.
大量体育活动（PA）与亚临床冠状动脉疾病（CAD）的较高患病率相关。然而，大量运动者中亚临床CAD的临床意义仍未完全了解，且大量PA与临床CAD事件之间的剂量反应关系仍不确定。
将库珀中心纵向研究（1987 - 2018年）的个体参与者数据与医疗保险理赔文件相链接。PA量通过自我报告确定，并分类为每周<500、500至1499、1500至2999以及≥3000代谢当量任务（MET）-分钟。亚临床CAD（冠状动脉钙化[CAC]）通过心脏计算机断层扫描测量。所有其他风险因素以标准方式测量。复合CAD事件（急性心肌梗死和血运重建）和全因死亡率由医疗保险理赔文件确定。使用具有随机共享脆弱性的多变量调整比例风险疾病 - 死亡模型来估计PA量、CAC与临床CAD和死亡之间的关联。通过乘法交互项确定不同PA水平下CAC与临床CAD之间关联的异质性。
我们纳入了26724名参与者（年龄54岁；28%为女性）。平均运动量为每周1130 MET - 分钟，其中1997人（7.5%）报告每周≥3000 MET - 分钟。经过平均20.5年的随访，我们观察到811例急性心肌梗死事件、1636例复合CAD事件以及2857例无CAD的死亡病例。与每周运动<500 MET - 分钟的个体相比，中等PA量（每周500 - 1499 MET - 分钟：风险比[HR]，0.77[95%CI，0.65 - 0.91]；每周1500 - 2499 MET - 分钟：HR，0.78[95%CI，0.63 - 0.95]）的个体发生急性心肌梗死的风险最低。大量PA（每周>3000 MET - 分钟）与急性心肌梗死风险之间无关联（HR，0.95[95%CI，0.72 - 1.25]）。相比之下，大量PA组的死亡风险最低（HR，0.71[95%CI，0.60 - 0.83]）。在所有PA类别中，包括大量PA亚组，CAC（对数尺度）与复合CAD的较高风险相关（HR，1.29[95%CI，1.16 - 1.44]；P<0.001；I² = 0.969）。
与低量PA相比，大量PA与全因死亡率较低风险相关，但与临床CAD风险相似。无论PA量如何，CAC都与临床CAD风险增加相关。
