Walking and Calcified Atherosclerotic Plaque in the Coronary Arteries: The National Heart, Lung, and Blood Institute Family Heart Study.
Studies have reported mixed findings on the association between physical activity and subclinical atherosclerosis. We sought to examine whether walking is associated with prevalent coronary artery calcification (CAC) and aortic calcification.



In a cross-sectional design, we studied 2971 participants of the National Heart, Lung, and Blood Institute Family Heart Study without a history of myocardial infarction, coronary artery bypass grafting, or percutaneous transluminal angioplasty. A standardized questionnaire was used to ascertain the number of blocks walked daily to compute walking metabolic equivalent hours. CAC was measured by cardiac computed tomography. We defined prevalent CAC and aortic calcification using an Agatston score of at least 100 and used generalized estimating equations to calculate adjusted prevalence ratios. Mean age was 55 years, and 60% of participants were women. Compared with the ≤3.75-Met-h/wk group, prevalence ratios for CAC after adjusting for age, sex, race, smoking, alcohol use, total physical activity (excluding walking), and familial clustering were 0.53 (95% confidence interval, 0.35-0.79) for >3.75 to 7.5 Met-h/wk, 0.72 (95% confidence interval, 0.52-0.99) for >7.5 to 15 Met-h/wk, and 0.54 (95% confidence interval, 0.36-0.81) for >15 to 22.5 Met-h/wk, (P trend=0.01). The walking-CAC relationship remained significant for those with body mass index ≥25 (P trend=0.02) and persisted with CAC cutoffs of 300, 200, 150, and 50 but not 0. When examined as a continuous variable, a J-shaped association between walking and CAC was found. The walking-aortic calcification association was not significant.



Our findings suggest that walking is associated with lower prevalent CAC (but not aortic calcification) in adults without known heart disease.
From the Department of Medicine, Brigham and Women's Hospital and Boston Veterans Affairs Healthcare System, Harvard Medical School, Boston, MA (T.F.I., Y.P., J.M.G., L.D.); Preventive Medicine and Epidemiology, Boston University School of Medicine, MA (R.C.E.); Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN (J.J.C.); Department of Epidemiology, University of Alabama at Birmingham (D.K.A.); Division of Epidemiology and Community Health, University of Minnesota, Minneapolis (J.S.P.); Department of Epidemiology, University of North Carolina, Chapel Hill (G.H.); and Cardiovascular Genetics, Department of Medicine, University of Utah, Salt Lake City (S.C.H.). TFImran@partners.org.
Tasnim F
TF
Imran
From the Department of Medicine, Brigham and Women's Hospital and Boston Veterans Affairs Healthcare System, Harvard Medical School, Boston, MA (T.F.I., Y.P., J.M.G., L.D.); Preventive Medicine and Epidemiology, Boston University School of Medicine, MA (R.C.E.); Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN (J.J.C.); Department of Epidemiology, University of Alabama at Birmingham (D.K.A.); Division of Epidemiology and Community Health, University of Minnesota, Minneapolis (J.S.P.); Department of Epidemiology, University of North Carolina, Chapel Hill (G.H.); and Cardiovascular Genetics, Department of Medicine, University of Utah, Salt Lake City (S.C.H.).
Yash
Y
Patel
From the Department of Medicine, Brigham and Women's Hospital and Boston Veterans Affairs Healthcare System, Harvard Medical School, Boston, MA (T.F.I., Y.P., J.M.G., L.D.); Preventive Medicine and Epidemiology, Boston University School of Medicine, MA (R.C.E.); Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN (J.J.C.); Department of Epidemiology, University of Alabama at Birmingham (D.K.A.); Division of Epidemiology and Community Health, University of Minnesota, Minneapolis (J.S.P.); Department of Epidemiology, University of North Carolina, Chapel Hill (G.H.); and Cardiovascular Genetics, Department of Medicine, University of Utah, Salt Lake City (S.C.H.).
R Curtis
RC
Ellison
From the Department of Medicine, Brigham and Women's Hospital and Boston Veterans Affairs Healthcare System, Harvard Medical School, Boston, MA (T.F.I., Y.P., J.M.G., L.D.); Preventive Medicine and Epidemiology, Boston University School of Medicine, MA (R.C.E.); Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN (J.J.C.); Department of Epidemiology, University of Alabama at Birmingham (D.K.A.); Division of Epidemiology and Community Health, University of Minnesota, Minneapolis (J.S.P.); Department of Epidemiology, University of North Carolina, Chapel Hill (G.H.); and Cardiovascular Genetics, Department of Medicine, University of Utah, Salt Lake City (S.C.H.).
J Jeffrey
JJ
Carr
From the Department of Medicine, Brigham and Women's Hospital and Boston Veterans Affairs Healthcare System, Harvard Medical School, Boston, MA (T.F.I., Y.P., J.M.G., L.D.); Preventive Medicine and Epidemiology, Boston University School of Medicine, MA (R.C.E.); Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN (J.J.C.); Department of Epidemiology, University of Alabama at Birmingham (D.K.A.); Division of Epidemiology and Community Health, University of Minnesota, Minneapolis (J.S.P.); Department of Epidemiology, University of North Carolina, Chapel Hill (G.H.); and Cardiovascular Genetics, Department of Medicine, University of Utah, Salt Lake City (S.C.H.).
Donna K
DK
Arnett
From the Department of Medicine, Brigham and Women's Hospital and Boston Veterans Affairs Healthcare System, Harvard Medical School, Boston, MA (T.F.I., Y.P., J.M.G., L.D.); Preventive Medicine and Epidemiology, Boston University School of Medicine, MA (R.C.E.); Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN (J.J.C.); Department of Epidemiology, University of Alabama at Birmingham (D.K.A.); Division of Epidemiology and Community Health, University of Minnesota, Minneapolis (J.S.P.); Department of Epidemiology, University of North Carolina, Chapel Hill (G.H.); and Cardiovascular Genetics, Department of Medicine, University of Utah, Salt Lake City (S.C.H.).
James S
JS
Pankow
From the Department of Medicine, Brigham and Women's Hospital and Boston Veterans Affairs Healthcare System, Harvard Medical School, Boston, MA (T.F.I., Y.P., J.M.G., L.D.); Preventive Medicine and Epidemiology, Boston University School of Medicine, MA (R.C.E.); Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN (J.J.C.); Department of Epidemiology, University of Alabama at Birmingham (D.K.A.); Division of Epidemiology and Community Health, University of Minnesota, Minneapolis (J.S.P.); Department of Epidemiology, University of North Carolina, Chapel Hill (G.H.); and Cardiovascular Genetics, Department of Medicine, University of Utah, Salt Lake City (S.C.H.).
Gerardo
G
Heiss
From the Department of Medicine, Brigham and Women's Hospital and Boston Veterans Affairs Healthcare System, Harvard Medical School, Boston, MA (T.F.I., Y.P., J.M.G., L.D.); Preventive Medicine and Epidemiology, Boston University School of Medicine, MA (R.C.E.); Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN (J.J.C.); Department of Epidemiology, University of Alabama at Birmingham (D.K.A.); Division of Epidemiology and Community Health, University of Minnesota, Minneapolis (J.S.P.); Department of Epidemiology, University of North Carolina, Chapel Hill (G.H.); and Cardiovascular Genetics, Department of Medicine, University of Utah, Salt Lake City (S.C.H.).
Steven C
SC
Hunt
From the Department of Medicine, Brigham and Women's Hospital and Boston Veterans Affairs Healthcare System, Harvard Medical School, Boston, MA (T.F.I., Y.P., J.M.G., L.D.); Preventive Medicine and Epidemiology, Boston University School of Medicine, MA (R.C.E.); Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN (J.J.C.); Department of Epidemiology, University of Alabama at Birmingham (D.K.A.); Division of Epidemiology and Community Health, University of Minnesota, Minneapolis (J.S.P.); Department of Epidemiology, University of North Carolina, Chapel Hill (G.H.); and Cardiovascular Genetics, Department of Medicine, University of Utah, Salt Lake City (S.C.H.).
J Michael
JM
Gaziano
From the Department of Medicine, Brigham and Women's Hospital and Boston Veterans Affairs Healthcare System, Harvard Medical School, Boston, MA (T.F.I., Y.P., J.M.G., L.D.); Preventive Medicine and Epidemiology, Boston University School of Medicine, MA (R.C.E.); Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN (J.J.C.); Department of Epidemiology, University of Alabama at Birmingham (D.K.A.); Division of Epidemiology and Community Health, University of Minnesota, Minneapolis (J.S.P.); Department of Epidemiology, University of North Carolina, Chapel Hill (G.H.); and Cardiovascular Genetics, Department of Medicine, University of Utah, Salt Lake City (S.C.H.).
Luc
L
Djoussé
D000328:Adult; D000368:Aged; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology / Q000517:prevention & control; D001027:Aortography / Q000379:methods; D000072226:Computed Tomography Angiography; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000473:pathology / Q000517:prevention & control; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D054555:National Heart, Lung, and Blood Institute (U.S.); D058226:Plaque, Atherosclerotic; D015995:Prevalence; D065840:Protective Factors; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D011795:Surveys and Questionnaires; D014481:United States; D061205:Vascular Calcification / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000473:pathology / Q000517:prevention & control; D016138:Walking
coronary artery calcification; cross-sectional studies; metabolic equivalent; physical activity; walking