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Comment & Response
May 2016

Fitness and Coronary Artery Calcification

Author Affiliations
  • 1Department of Physiology, Radboud university medical center, Nijmegen, the Netherlands
  • 2Research Institute of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
JAMA Intern Med. 2016;176(5):716. doi:10.1001/jamainternmed.2016.0898

To the Editor With great interest we read the article by Shah et al1 in a recent issue of JAMA Internal Medicine in which they showed that higher levels of cardiorespiratory fitness during early adulthood are associated with a reduced risk for cardiovascular diseases (CVD) (hazard ratio [HR], 0.88; 95% CI, 0.81-0.96) and all-cause mortality (HR, 0.85; 95% CI, 0.80-0.91) later in life. The authors found no association between fitness and coronary artery calcification (CAC). Although this finding may not fit the general dogma that CAC is lower with elevated levels of fitness,2 we propose that high levels of fitness acquired by exercise training may actually increase CAC. In fact, data from Shah et al support this hypothesis; CAC presence increased per fitness tertile (24.3% vs 25.9% vs 34.6%, respectively) (P < .001) in participants of the CARDIA study (n = 4872).1 Also, association analyses demonstrated an increased risk for the presence of CAC per 1-minute increase in treadmill exercise duration after 15 years (odds ratio [OR], 1.05; 95% CI, 1.01-1.10), 20 years (OR, 1.05; 95% CI, 1.01-1.08) and 25 years follow-up (OR, 1.07; 95% CI, 1.04-1.10).1

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