Korean study shows a positive and graded association between physical activity and coronary artery calcification

 A large prospective study (1) from Korea demonstrated a positive relationship between self-reported physical activity and coronary artery calcification (CAC) scores.

There is overwhelming epidemiological evidence that regular exercise is associated with decreased risk of cardiovascular and all-cause mortality.Data indidcate that small amount of exercise is beneficial in that regard and that more seems  better.A panel in 2018 recommended as a minimum 500 met hours per week which is equivalent to 2.5 hours of moderate exercise or 1.25 hrs of vigorous ( greater than 7 Mets) exercise.

Eijesvogel in his comprehensive analysis of the " extreme exercise hypothesis" noted  that the maximum reduction in CV morality was noted at 41 Met hrs per week which is five times the minimum recommended level.  So there is a well defined linear relationship between exercise volume and CV mortality and so far data have not indicated a J shaped curve in that regard.

Defina et al (2) demonstrated that high levels of physical activity ( 3,000Met min per week which is five times the minimum 2018 recommended level) was associated with  prevalent CAC but was not associated with increase in CV disease mortality..Other publicaions have  also demonstrated an increase in coronary calcification in long time endurance athletes .

Sung's article now provides a "positive , graded association between physical activity and progression of coronary calcification, regardless of CAC scores". 

Quoting Sung ;"The standard Agatson CAC scores are calculated as a combination of calcium density and the volume of plaque burden. Higher calcium density,which suggests a more stable calcified plaque, produces a higher CAC score, however it is associated with lower CAD risk."

Both long time endurance exercise and long term use of statins are associated with increased coronary artery calcification  but  lower CV morality.

1)Sung,K et al Physical activity and the progression of coronary artery calcification. Heart 2021;0:1-7,

2) Defina,LF at al Association of all-cause and cardiovascular mortality with high levels of physical activity  and concurrent coronary artery calcifications,JAMA Cardiology, 2019 42 (2) p 174