Exercising may paradoxically accelerate the worsening of an important risk factor for heart attacks: calcium deposits in coronary arteries, one of the most important markers used to assess cardiovascular disease risk. In a new study done by a team of doctors from 2 major health centers in Seoul and Suwon (South Korea) and which was published in the journal Heart the researchers do not dispute the cardiovascular benefits of exercise but suggest that in some patients, clinicians should consider that exercise may also promote coronary calcium accumulation.
The coronary artery calcium score (CAC) is used to guide treatments that are aimed to reduce the risk of heart attacks and strokes. In fact, statins are now indicated for most people with a CAC score of 100 or more.
Can exercise worsen arterial stiffness?
This study showed that despite significant health benefits – including reductions in the risk of obesity, diabetes, heart attacks, and death, among others – people that are very active physically appear to have increased levels of calcium in their coronary arteries. This suggests that exercise may be indirectly related to the development of arterial stiffness.
The Kangbuk Samsung Health study
the Korean team subjected 25,485 participants (22,741 men and 2,744 women), aged 30 years and older, to extensive health checks between March 2011 and December 2017. At each check-up, participants provided information on their medical and family history, lifestyle, and education, and their weight (BMI), blood pressure, and blood lipids were also assessed. Their exercise or physical activity was also recorded. Finally, any calcification of the coronary arteries was assessed and monitored using the CAC score over an average period of 3 years.
- 47% (11,920) of the participants were inactive
- 38% (9,683) were moderately active
- 15% (3,882) were vigorously active (6.5 km of running per day)
The analysis showed:
- The more physically active participants were likely to be older and smoke less than the less active participants.
- Their total cholesterol was lower but had higher blood pressure, and evidence of calcium deposits in the arteries.
- A relationship between physical activity levels and the progression of coronary calcification over time, regardless of CAC scores at the start of the control period,
- The estimated CAC calcification scores in the 3 groups at inclusion were 9.45, 10.20, and 12.04, respectively,
- Increased intensity of physical activity was associated with a faster increase in CAC scores in both those that started without calcification and those with baseline CAC scores.
- Compared with inactive participants, the mean increase in CAC scores over 5 years for moderately and vigorously active participants was 3.20 and 8.16, respectively, even after controlling for potential confounding factors such as BMI, blood pressure, and blood lipids.
Physical activity, a potential factor in coronary atherosclerosis
The observational study found a strong association between physical activity and arterial calcification but did not prove a causal relationship. The authors concluded that it is possible that physical activity increases coronary atherosclerosis or arterial stenosis through the effect of mechanical stress and damage to the vascular wall. Physical activity may also induce these calcification and atherosclerotic effects through physiological responses such as an increase in blood pressure and parathyroid hormone levels. In addition, exercise can indirectly alter food, vitamin, and mineral intake.
Overdoing anything can hurt our health and that includes exercising. So there should be no dought that moderate physical activity over the long term is the best way to stay healthy. Although in this study the researchers do not dispute the cardiovascular health benefits of physical activity, they do draw physicians’ attention to the risk of calcification in some patients with high cardiac risk. In short, don’t put too much stress on your body if you want to avoid not only heart attacks but also repetitive use injuries.