Dataset Information

Assessment of Coronary Atherosclerosis Using Calcium Scores in Short- and Long-Distance Runners.

ABSTRACT:

Objective

To determine whether there is a "dose-dependent" relationship between coronary atherosclerosis and the burden of exercise.

Background

Recent data have suggested there may be negative consequences related to strenuous exercise. Previous studies evaluating the presence of coronary atherosclerosis as assessed by coronary calcium scores have been confounded by the presence of other cardiovascular risk factors. We aimed to assess whether there was a relationship between the burden of coronary calcium and the amount of running in a local cohort.

Patients and methods

Eighty-five runners were screened on the basis of an exercise questionnaire that was later used to determine the experimental groups from January 2016 through October 2016. Twenty-nine individuals were excluded from the study because of the presence of preexisting cardiovascular risk factors. Runners were divided into 3 categories: Group A comprised runners who had competed in at least 10 ultramarathons and/or Ironman competitions in 10 years. Group B included runners who had participated in more than 9 marathons over 10 years. Group C comprised runners who had competed in more than 9 shorter races over 10 years. Coronary artery calcium (CAC) scores were assessed by computed tomography. Statistical analysis was performed using chi-square analyses. Logistic regression models were used to assess the relationship between runner groups and calcium score greater than 100, calcium score percentile, and calcium score greater than 0.

Results

There were no differences between groups A and B for CAC scores greater than 0 or greater than 100, and a similar percentage of group A and B athletes had scores greater than the 50th percentile. Groups A and B were combined for further analysis. Among those runners participating in extreme distance running (groups A and B), 73% of runners had CAC scores greater than 0 whereas only 21% of group C runners had CAC scores greater than 0 (P=.0002). Moreover, 70% of group A + B athletes ranked above the 50th percentile of their age and sex as assessed by a national database (Hoff JA, Chomka EV, Krainik AJ, Daviglus M, Rich S, Kondos GT. Age and gender distributions of coronary artery calcium detected by electron beam tomography in 35,246 adults. Am J Cardiol. 2001;87(12):1335-1339), whereas only 19% of group C runners were ranked above the 50th percentile (P=.0001). One-third of runners in group A + B had CAC scores greater than 100 as compared with only 12% of runners in group C (P=.05). When controlling for age, sex, and number of years running, the study group was not a significant predictor of CAC greater than 100 (P=.12). In contrast, group A + B was 10 times more likely than group C to have CAC scores in the 50th percentile or greater (P=.02) and 8.8 times more likely to have a abnormal calcium score when controlling for covariates (P=.03).

Conclusion

A significantly higher rate of coronary artery calcification existed in long-term marathon, ultramarathon, and extreme runners than in submarathon runners. Marathoners and ultramarathoners also had a higher incidence of calcification, as well as higher average plaque burden, as compared to a standard database. Marathoners and ultramarathoners also had above-average coronary calcium scores as compared to a national database.

SUBMITTER: Jafar O

PROVIDER: S-EPMC6543495 | biostudies-literature | 2019 Jun

REPOSITORIES: biostudies-literature

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Publications

Assessment of Coronary Atherosclerosis Using Calcium Scores in Short- and Long-Distance Runners.

Jafar Omar O Friedman Jason J Bogdanowicz Ian I Muneer Aamir A Thompson Paul D PD Ling Julie J Messina Anthony A Yen Michael M Wakefield Dorothy D Varanasi Pranav P Haleem Kamran K

Mayo Clinic proceedings. Innovations, quality & outcomes 20190527 2

<h4>Objective</h4>To determine whether there is a "dose-dependent" relationship between coronary atherosclerosis and the burden of exercise.<h4>Background</h4>Recent data have suggested there may be negative consequences related to strenuous exercise. Previous studies evaluating the presence of coronary atherosclerosis as assessed by coronary calcium scores have been confounded by the presence of other cardiovascular risk factors. We aimed to assess whether there was a relationship between the b ...[more]

PMID: 31193888

Similar Datasets

Project description:ObjectivesIn this study, we aimed to establish whether age-sex-specific percentiles of coronary artery calcium (CAC) predict cardiovascular outcomes better than the actual (absolute) CAC score.BackgroundThe presence and extent of CAC correlates with the overall magnitude of coronary atherosclerotic plaque burden and with the development of subsequent coronary events.MethodsMESA (Multi-Ethnic Study of Atherosclerosis) is a prospective cohort study of 6,814 asymptomatic participants followed for coronary heart disease (CHD) events including myocardial infarction, angina, resuscitated cardiac arrest, or CHD death. Time to incident CHD was modeled with Cox regression, and we compared models with percentiles based on age, sex, and/or race/ethnicity to categories commonly used (0, 1 to 100, 101 to 400, 400+ Agatston units).ResultsThere were 163 (2.4%) incident CHD events (median follow-up 3.75 years). Expressing CAC in terms of age- and sex-specific percentiles had significantly lower area under the receiver-operating characteristic curve (AUC) than when using absolute scores (women: AUC 0.73 versus 0.76, p = 0.044; men: AUC 0.73 versus 0.77, p < 0.001). Akaike's information criterion indicated better model fit with the overall score. Both methods robustly predicted events (>90th percentile associated with a hazard ratio [HR] of 16.4, 95% confidence interval [CI]: 9.30 to 28.9, and score >400 associated with HR of 20.6, 95% CI: 11.8 to 36.0). Within groups based on age-, sex-, and race/ethnicity-specific percentiles there remains a clear trend of increasing risk across levels of the absolute CAC groups. In contrast, once absolute CAC category is fixed, there is no increasing trend across levels of age-, sex-, and race/ethnicity-specific categories. Patients with low absolute scores are low-risk, regardless of age-, sex-, and race/ethnicity-specific percentile rank. Persons with an absolute CAC score of >400 are high risk, regardless of percentile rank.ConclusionsUsing absolute CAC in standard groups performed better than age-, sex-, and race/ethnicity-specific percentiles in terms of model fit and discrimination. We recommend using cut points based on the absolute CAC amount, and the common CAC cut points of 100 and 400 seem to perform well.

Project description:Running practice could generate musculoskeletal adaptations that modify the body mechanics and generate different biomechanical patterns for individuals with distinct levels of experience. Therefore, the aim of this study was to investigate whether foot-ankle kinetic and kinematic patterns can be used to discriminate different levels of experience in running practice of recreational runners using a machine learning approach. Seventy-eight long-distance runners (40.7 ± 7.0 years) were classified into less experienced (n = 24), moderately experienced (n = 23), or experienced (n = 31) runners using a fuzzy classification system, based on training frequency, volume, competitions and practice time. Three-dimensional kinematics of the foot-ankle and ground reaction forces (GRF) were acquired while the subjects ran on an instrumented treadmill at a self-selected speed (9.5-10.5 km/h). The foot-ankle kinematic and kinetic time series underwent a principal component analysis for data reduction, and combined with the discrete GRF variables to serve as inputs in a support vector machine (SVM), to determine if the groups could be distinguished between them in a one-vs.-all approach. The SVM models successfully classified all experience groups with significant crossvalidated accuracy rates and strong to very strong Matthew's correlation coefficients, based on features from the input data. Overall, foot mechanics was different according to running experience level. The main distinguishing kinematic factors for the less experienced group were a greater dorsiflexion of the first metatarsophalangeal joint and a larger plantarflexion angles between the calcaneus and metatarsals, whereas the experienced runners displayed the opposite pattern for the same joints. As for the moderately experienced runners, although they were successfully classified, they did not present a visually identifiable running pattern, and seem to be an intermediate group between the less and more experienced runners. The results of this study have the potential to assist the development of training programs targeting improvement in performance and rehabilitation protocols for preventing injuries.

Project description:ImportanceThe interplay of self-rated health (SRH), coronary artery calcium (CAC) scores, and cardiovascular risk is poorly described.ObjectivesTo assess the degree of correlation between SRH and CAC, to determine whether these measures are complementary for risk prediction, and to assess the incremental value of the addition of SRH to established risk tools.Design, setting, and participantsThe Multi-Ethnic Study of Atherosclerosis (MESA) is a large population-based prospective cohort study of adults aged 45 to 84 years who were recruited from 6 US communities. A total of 6764 participants without baseline cardiovascular disease (CVD) were included in the analysis. Data were collected from July 2000 through August 2002. Follow-up was completed by December 2013, and data were analyzed from October 2018 to December 2018.ExposuresThe EVGGFP (excellent, very good, good, fair, and poor) self-assessment of overall health (assessed before the baseline study examination) and CAC score. The EVGGFP rating was categorized as poor/fair, good, very good, or excellent.Main outcomes and measuresHard coronary heart disease (CHD) events, hard CVD events, and all-cause mortality during a median follow-up of 13.2 years (interquartile range, 12.7-13.7 years).ResultsAmong the study population of 6764 participants, the mean (SD) age was 62.1 (10.2) years, and 52.9% were women. The EVGGFP rating was strongly associated with age, sex, race/ethnicity, educational and income levels, healthy diet and physical activity, and cardiovascular risk factors. Despite encapsulating many risk variables, no correlation (r = -0.007; P = .57) or association between EVGGFP and the presence (χ2 = 0.84; P = .84) or severity (χ2 = 4.64; P = .86) of CAC was found. During follow-up, 1161 deaths, 637 hard CVD events, and 405 hard CHD events were recorded. In models adjusted for age, sex, race/ethnicity, and CAC, participants who reported excellent health had a 45% lower risk of CVD (hazard ratio [HR], 0.55; 95% CI, 0.39-0.77) and a 42% lower risk of CHD (HR, 0.58; 95% CI, 0.37-0.90) compared with those who reported poor/fair health. Participants in the excellent SRH category who had any CAC had markedly elevated risk of hard CHD (HR, 6.19; 95% CI, 2.1-18.3) and CVD (HR, 6.50; 95% CI, 2.7-15.6) events compared with those with a CAC score of 0. The addition of the EVGGFP rating to CAC improved the area under the curve (C statistic) for CHD events (0.725 vs 0.734; P = .007), CVD events (0.693 vs 0.706; P < .001), and all-cause mortality (0.685 vs 0.707; P < .001). However, the addition of the EVGGFP rating to the combination of CAC and atherosclerotic CVD risk score did not significantly improve C statistics for CHD events (0.751 vs 0.753; P = .39), CVD events (0.739 vs 0.741; P = .18), or all-cause mortality (0.779 vs 0.781; P = .13).Conclusions and relevanceAlthough SRH and CAC integrate many risk variables, this study suggests that they are poorly correlated and have complementary predictive utility. A perception of excellent health does not obviate the need for definitive assessment of CVD risk, whereas fair/poor perceived health may serve as a risk enhancer, arguing for advanced risk assessment in selected clinical scenarios.

Project description:AimThis study explores the association between Coronary Artery Calcium (CAC) scores and dental pathology such as missing teeth, the (peri-apical) health status and restoration grade of the teeth, and the grade of alveolar bone loss seen on a dental panoramic radiograph (Orthopantomograph-OPG).Materials and methodsIn this retrospective cross-sectional study, data was collected from three hospitals spread in the Netherlands. Patients were included when a CAC score and an OPG were available, both recorded within a maximum period of 365 days from 2009-2017. The CAC score was measured on a CT scan, using the Agatston method. To assess dental pathology, the number of missing teeth, the number of dental implants, alveolar bone loss, caries, endodontic treatments, peri-apical radiolucencies, bone loss at implants, impacted teeth and dental cysts, were determined on the OPG. All observers were calibrated. The electronic health records provided information about: gender, age, smoking, Diabetes Mellitus, hypercholesterolemia, hypertension and Body Mass Index (BMI).Results212 patients were included. We found a statistically significant association between the number of missing teeth and the CAC score. When modeling age, sex, and other well-known risk factors for cardiovascular disease, the significant correlation was no longer present after multivariate correction. Furthermore, the results showed a trend for more teeth with peri-apical lesions and a higher percentage of mean alveolar bone loss in the group with the highest CAC scores.ConclusionThis study showed that being edentulous or missing teeth is correlated to higher CAC scores however failed to be an independent predictor of atherosclerotic cardiovascular diseases. The number of (missing) teeth is an easily accessible marker and could be used as a marker for atherosclerotic cardiovascular disease (ACVD) risk by almost any healthcare worker. The current study needs to be considered as an explorative pilot study and could contribute to the design of further (prospective) studies on the relationship between dental pathology and coronary artery calcification by adding clinical information and extra cardiovascular biomarkers.

Dataset Information

Assessment of Coronary Atherosclerosis Using Calcium Scores in Short- and Long-Distance Runners.

Objective

Background

Patients and methods

Results

Conclusion

Publications

Assessment of Coronary Atherosclerosis Using Calcium Scores in Short- and Long-Distance Runners.

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