title: Physical activity, C-reactive protein levels and the risk of future coronary artery disease in apparently healthy men and women: the EPIC-Norfolk prospective population study.
abstract: BACKGROUND
  Physical activity is inversely associated with the risk of future coronary artery disease. Whether this relationship is in part mediated by lower levels of systemic inflammation, as indicated by C-reactive protein concentrations, is unknown.
  
  
  METHODS
  We performed a nested case-control study among apparently healthy men and women enrolled in the European Prospective Investigation into Cancer and Nutrition-Norfolk prospective population study, to investigate the relationship among habitual (work-related and leisure time) physical activity, cardiovascular risk factors and the risk of future coronary artery disease.
  
  
  RESULTS
  Among men, those with an active lifestyle had a significantly lower risk of future coronary artery disease than those with an inactive lifestyle [odds ratio (OR) 0.65; 95% confidence interval (CI) 0.47-0.90; P for linearity, 0.008], after adjustment for smoking, systolic blood pressure, diabetes, body mass index and low-density lipoprotein and high-density lipoprotein cholesterol. Additional adjustment for C-reactive protein levels attenuated this relationship only slightly (OR 0.68; 95%CI 0.49-0.93; P for linearity, 0.02). Similarly, active women had an adjusted odds ratio of 0.48 (0.28-0.82; P for linearity <0.001) for future coronary artery disease compared with inactive women. Additional adjustment for C-reactive protein levels attenuated this relationship slightly (OR 0.51; 0.30-0.87; P for linearity, 0.003).
  
  
  CONCLUSIONS
  We observed that people with an active lifestyle had a substantially lower risk of future coronary artery disease than people with an inactive lifestyle, and that this relationship was partly mediated through lower levels of established cardiovascular risk factors and in addition, C-reactive protein. This observation suggests that reduced systemic inflammation may be one of the mechanisms through which physical activity leads to reduced cardiovascular risk.
authors.affiliation: Department of Cardiology, Academic Medical Centre, Amsterdam, The Netherlands. s.m.boekholdt@amc.uva.nl
authors.forename: S Matthijs
authors.initials: SM
authors.lastname: Boekholdt
authors.forename: Manjinder S
authors.initials: MS
authors.lastname: Sandhu
authors.forename: Nicholas E
authors.initials: NE
authors.lastname: Day
authors.forename: Robert
authors.initials: R
authors.lastname: Luben
authors.forename: Sheila A
authors.initials: SA
authors.lastname: Bingham
authors.forename: Ron J G
authors.initials: RJ
authors.lastname: Peters
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Wareham
authors.forename: Kay-Tee
authors.initials: KT
authors.lastname: Khaw
mesh_terms: D000368:Aged; D002097:C-Reactive Protein / Q000378:metabolism*; D016022:Case-Control Studies; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D009043:Motor Activity; D011446:Prospective Studies; D012307:Risk Factors; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D002097:C-Reactive Protein