Zuo Luoshiyuan, Kavousi Maryam, Van Oortmerssen Julie A E, Voortman Trudy, Ikram M Kamran, Bos Daniel
Department of Epidemiology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands.
Department of Epidemiology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands; Meta-Research Innovation Centre at Stanford (METRICS), Stanford University, Stanford, USA.
EBioMedicine. 2025 Aug 20;119:105894. doi: 10.1016/j.ebiom.2025.105894.
Recent evidence suggests that excessive physical activity may accelerate the progression of coronary atherosclerosis. However, data on carotid atherosclerosis remains scarce. This study aimed to evaluate the association between physical activity and changes in carotid atherosclerotic plaque vulnerability, and the interaction between these two variables with the risk of first-ever stroke.
This prospective study included 1330 stroke-free persons (mean age: 71.5 years) from the population-based Rotterdam Study with carotid atherosclerosis. Carotid magnetic resonance imaging (MRI) was performed to assess intraplaque haemorrhage (IPH) and lipid-rich necrotic core (LRNC), both recognised as important vulnerable plaque components, with a follow-up MRI conducted approximately six years later in 699 participants. Physical activity was assessed using a questionnaire at baseline MRI. The association of physical activity with incident plaque components and the interaction between these two variables with the risk of stroke were analysed, adjusting for socioeconomic status and conventional cardiovascular risk factors.
Higher volumes of total, moderate-to-vigorous, and vigorous physical activity were associated with an increased risk of incident IPH and LRNC, with adjusted odds ratio (OR) ranging from 1.08 to 1.35 per 20 metabolic equivalent of task (MET)-hours/week increase. Physical activity was further categorised using literature-based cut-offs, tertiles, quartiles, and quintiles, with the lowest group as the reference. The risk of incident IPH was significantly higher exclusively in the top quintiles of total, moderate-to-vigorous, and vigorous physical activity (adjusted OR range: 1.87-2.54, all P < 0.05), with thresholds of potential harm (99, 70, and 26 MET-hours/week, respectively) substantially exceeding current guideline recommendations for cardiovascular disease prevention (15, 15, and 7.5 MET-hours/week, respectively); similar patterns were also observed for LRNC. No association was found for moderate activity. The association between physical activity and first-ever stroke differed by the presence of vulnerable plaque components at baseline (P for interaction = 0.010 for total, 0.095 for moderate-to-vigorous), and physical activity inversely associated with stroke only in individuals without vulnerable plaque components (adjusted hazard ratio range: 0.69-0.71, all P < 0.05).
In older individuals with pre-existing carotid atherosclerosis, the most physically active group may have a higher risk of developing vulnerable carotid plaques. Individuals with pre-existing vulnerable carotid plaques may lose the benefits of physical activity.
The Rotterdam Study is supported by the Erasmus Medical Center and Erasmus University Rotterdam; the Netherlands Organisation for Scientific Research (NWO); the Netherlands Organisation for Health Research and Development (ZonMw); the Research Institute for Diseases in the Elderly (RIDE); the Netherlands Genomics Initiative (NGI); the Ministry of Education, Culture and Science, the Ministry of Health, Welfare and Sports; the European Commission (DG XII); and the Municipality of Rotterdam. This work was further supported by the Leducq Foundation COMET Network. The funder of the study had no role in study design, data collection, data analysis, data interpretation, writing, or submission of the report.
最近的证据表明，过度的体力活动可能会加速冠状动脉粥样硬化的进展。然而，关于颈动脉粥样硬化的数据仍然很少。本研究旨在评估体力活动与颈动脉粥样硬化斑块易损性变化之间的关联，以及这两个变量与首次中风风险之间的相互作用。
这项前瞻性研究纳入了基于人群的鹿特丹研究中1330名无中风且患有颈动脉粥样硬化的人（平均年龄：71.5岁）。进行颈动脉磁共振成像（MRI）以评估斑块内出血（IPH）和富含脂质的坏死核心（LRNC），这两者均被认为是重要的易损斑块成分，约六年后对699名参与者进行了随访MRI。在基线MRI时使用问卷评估体力活动。分析了体力活动与新发斑块成分的关联以及这两个变量与中风风险之间的相互作用，并对社会经济状况和传统心血管危险因素进行了校正。
总体力活动量、中度至剧烈体力活动量和剧烈体力活动量较高与新发IPH和LRNC风险增加相关，每增加20代谢当量任务（MET）-小时/周，校正后的比值比（OR）范围为1.08至1.35。根据基于文献的临界值、三分位数、四分位数和五分位数对体力活动进行进一步分类，以最低组作为参照。仅在总体力活动量、中度至剧烈体力活动量和剧烈体力活动量的最高五分位数中，新发IPH的风险显著更高（校正后的OR范围：1.87 - 2.54，所有P < 0.05），潜在危害阈值（分别为99、70和26 MET-小时/周）大大超过了当前心血管疾病预防指南的建议（分别为15、15和7.5 MET-小时/周）；LRNC也观察到类似模式。未发现中度活动存在关联。体力活动与首次中风之间的关联因基线时是否存在易损斑块成分而异（总体力活动的交互作用P = 0.010，中度至剧烈体力活动的交互作用P = 0.095），并且体力活动仅在没有易损斑块成分的个体中与中风呈负相关（校正后的风险比范围：0.69 - 0.71，所有P < 0.05）。
在已有颈动脉粥样硬化的老年人中，体力活动最多的组可能发生易损颈动脉斑块的风险更高。已有易损颈动脉斑块的个体可能无法从体力活动中获益。
鹿特丹研究由伊拉斯姆斯医学中心和鹿特丹伊拉斯姆斯大学、荷兰科学研究组织（NWO）、荷兰卫生研究与发展组织（ZonMw）、老年疾病研究所（RIDE）、荷兰基因组计划（NGI）、教育、文化和科学部、卫生、福利和体育部、欧盟委员会（DG XII）以及鹿特丹市资助。这项工作还得到了勒杜克基金会COMET网络的进一步支持。该研究的资助者在研究设计、数据收集、数据分析、数据解读、撰写或报告提交方面没有任何作用。
