Dangerous Paradox: Physical Activity May Hasten Build-Up of Heart Attack Risk Factor

Heart Attack Illustration

Linked to calcium deposits in coronary arteries, used to measure heart problems threat However findings don’t outweigh quite a few well being advantages of train, emphasize researchers.

Physical exercise might paradoxically hasten the build-up of calcium deposits (plaque) within the coronary arteries, the quantity of which is used to evaluate future heart problems threat, finds analysis printed on-line within the journal Heart.

However the findings don’t outweigh the quite a few well being advantages of train, emphasize the researchers. 

The coronary artery calcium rating, or CAC rating for brief, is used to information remedy to beat back a coronary heart assault or stroke. Statins are indicated for most individuals with a CAC rating of 100 or above.

Common bodily exercise is related to a dose-dependent discount within the threat of weight problems, diabetes, coronary heart assault/stroke, and demise, amongst different issues. 

However the analysis exhibits that regardless of these vital well being advantages people who find themselves very bodily energetic appear to have excessive ranges of calcium deposits of their coronary arteries. So it’s not clear if train might itself be related to calcification (artery hardening).

In a bid to discover this additional, the researchers studied wholesome adults who underwent common complete check-ups at two main well being facilities in Seoul and Suwon, South Korea, between March 2011 and December 2017, as half of the Kangbuk Samsung Well being Research. 

At every well being examine, individuals crammed out a questionnaire, which included questions on medical and household historical past, way of life, and academic attainment.  Weight (BMI), blood strain, and blood fat have been additionally assessed.

Physical exercise was formally categorized on the first check-up as both inactive, reasonably energetic, or ‘health-enhancing’ (intensely) bodily energetic, utilizing a validated questionnaire. 

Scans tracked the event and/or development of coronary artery calcification which was then scored (CAC rating) over a mean interval of 3 years.

Some 25,485 folks (22,741 males and 2744 ladies), aged at the least 30, and with at the least two CAC scores, have been included within the remaining evaluation.

Some 47% (11,920), 38% (9683), and 15% (3882) of them have been, respectively, inactive, reasonably energetic, and intensely bodily energetic–equal to operating 6.5 km/day. 

Those that have been extra bodily energetic tended to be older and fewer prone to smoke than much less bodily energetic individuals. In addition they had decrease complete ldl cholesterol, extra hypertension, and present proof of calcium deposits of their coronary arteries.

A graded affiliation between bodily exercise stage and the prevalence and development of coronary artery calcification emerged over time, irrespective of CAC scores at first of the monitoring interval.

The estimated adjusted common CAC scores in all three teams at first of the monitoring interval have been 9.45, 10.20, and 12.04, respectively. 

However greater bodily exercise was related to quicker development of CAC scores each in these with no calcium deposits and in those that already had a CAC rating at first of the monitoring interval.

In contrast with those that have been inactive, the estimated adjusted 5-year common will increase in CAC scores in reasonably and intensely energetic individuals have been 3.20 and eight.16, respectively, even after accounting for probably influential elements, together with BMI, blood strain, and blood fat.

That is an observational research, and as such, can’t set up trigger. The researchers additionally acknowledge a number of research limitations, together with the absence of an goal evaluation of bodily exercise; and no knowledge on incident coronary heart assaults/stroke or on CAC density or quantity. 

Physical exercise might improve coronary atherosclerosis (artery narrowing) by mechanical stress and vessel wall damage and thru the physiological responses it prompts, similar to will increase in blood strain and parathyroid hormone, they clarify. Physical exercise may additionally modify the impact of eating regimen, nutritional vitamins, and minerals, they counsel.

“The second chance is that bodily exercise might improve CAC scores with out rising [cardiovascular disease] threat,” they write.

“The cardiovascular advantages of bodily exercise are unquestionable,” they emphasize, reiterating nationwide tips recommending at the least 150–300 minutes/week of average depth or 75–150 minutes/week of vigorous depth cardio bodily exercise.

“Sufferers and physicians, nonetheless, want to think about that participating in bodily exercise might speed up the development of coronary calcium, probably attributable to plaque therapeutic, stabilization and calcification,” they conclude.

In a linked editorial, Drs Gaurav Gulsin and Alastair James Moss, of the Division of Cardiovascular Science, College of Leicester, ask: “Do these findings imply that we should always cease utilizing coronary artery calcium scores to evaluate coronary artery illness?”

The research highlights the complexity of decoding CAC scores in sufferers who’ve upped their bodily exercise or began taking statins – additionally related to greater scores, they level out. 

“Whereas proponents would argue that it’s an efficient device to display screen for subclinical atherosclerosis in asymptomatic people, clinicians ought to be cautious concerning the overuse of this take a look at in in any other case wholesome people,” they warning.

In a linked podcast, Dr. Moss explains that non-calcified plaque, which is extra unstable and extra prone to rupture, could also be extra vital and ought to be scored to evaluate an individual’s future threat of a coronary heart assault or stroke.

“It might be the goal we have to search for is non-calcified plaque relatively than calcified plaque,” he suggests. This wasn’t seen on the scans used on this research.

“Growing charges of coronary artery calcification is a phenomenon that’s noticed each in response to efficient remedy like statin remedy and train. But it surely shouldn’t essentially be regarded that serial imaging with calcium scans is one of the best ways to precisely assess [cardiovascular disease] threat in these people. 

However he reiterates: “Clearly, train is one of the very best methods of making an attempt to regulate cardiovascular threat in [people without symptoms].”


“Physical exercise and the development of coronary artery calcification” by Ki-Chul Sung, Yun Soo Hong, Jong-Younger Lee, Seung-Jae Lee, Yoosoo Chang, Seungho Ryu, Di Zhao, Juhee Cho, Eliseo Guallar and Joao A C Lima, 20 September 2021, Heart.
DOI: 10.1136/heartjnl-2021-319346

“Coronary artery calcium paradox and bodily exercise” by Gaurav S Gulsin and Alastair James Moss, 20 September 2021, Heart.
DOI: 10.1136/heartjnl-2021-319868
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