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Physical activity, 25-(OH)D jointly influence atherosclerotic CVD risk
Addressing suboptimal levels of 25-hydroxyvitamin D, combined with efforts to increase physical activity, may lower the risk for developing atherosclerotic cardiovascular disease in otherwise healthy adults, although the observed association was greater in white vs. black adults, according to findings from a cross-sectional, prospective study.
“Despite abundant evidence that [physical activity] and 25-(OH)D are each individually related to [CV] outcomes, their joint association with [atherosclerotic] CVD outcomes has been largely unexplored,” Erin D. Michos, MD, MHS, FACC, FAHA, associate professor of medicine and epidemiology and associate director of preventive cardiology at the Ciccarone Center for the Prevention of Heart Disease at Johns Hopkins University School of Medicine, and colleagues wrote. “As both 25-(OH)D and [physical activity] levels are potentially modifiable in individuals, this information might help refine future prevention strategies regarding [atherosclerotic] CVD risk.”
Michos and colleagues analyzed data from 10,342 white and black adults aged 45 to 64 years free of atherosclerotic CVD at baseline participating in the ARIC study, an ongoing cohort from four U.S. communities: Forsyth County, North Carolina; Jackson, Mississippi; suburbs of Minneapolis; and Washington County, Maryland (mean age, 54 years; 57.5% women; 20.7% black). Moderate/vigorous intensity physical activity was assessed via a modified Baecke questionnaire at baseline (1987-1989) and categorized per American Heart Association (AHA) guidelines (recommended, intermediate or poor). Primary outcome was serum 25-(OH)D level between 1990 and 1992 and atherosclerotic CVD events (incident MI, fatal coronary disease or stroke) through 2013.
During a mean follow-up of 19.3 years, 1,800 incident atherosclerotic CVD events occurred.
Within the cohort, overall mean 25-(OH)D level was 24.7 ng/mL; 39.6% of participants met AHA levels for physical activity. Those who achieved AHA-recommended guidelines for physical activity had higher mean levels of 25-(OH)D vs. those with intermediate and poor levels of physical activity (26.6 ng/mL vs. 24.4 ng/mL and 22.7 ng/mL, respectively). Those who achieved recommended physical activity levels also had a 31% lower risk for 25-(OH)D deficiency, according to researchers (RR = 0.69; 95% CI, 0.63-0.75).
In white adults, researchers observed a “nearly linear” association between physical activity and 25-(OH)D levels with no evidence of a dose threshold. Among black adults, levels of 25-(OH)D “plateaued at higher [physical activity] levels,” although researchers noted the data were based on fewer observations.
White adults meeting recommended physical activity levels were 37% less likely to be deficient in 25-(OH)D (RR = 0.63; 95% CI, 0.56-0.71), but there was no significant association in black adults (RR = 0.93; 95% CI, 0.9-1.07).
Among patients with optimal levels of 25-(OH)D ( 30 ng/mL), those who achieved intermediate or recommended physical activity levels had a 35% lower risk for incident atherosclerotic CVD vs. those who were deficient in 25-(OH)D and had poor physical activity levels; results were independent of demographic factors (HR = 0.64; 05% CI, 0.5-0.83) and lifestyle factors (HR = 0.62; 95% CI, 0.51-0.76). Participants with intermediate 25-(OH)D levels and intermediate physical activity levels did not have a reduced risk for incident atherosclerotic CVD.
“These findings suggest that future clinical strategies to prevent atherosclerotic cardiovascular disease may be more effective by increasing suboptimal levels of 25-(OH)D in addition to efforts to increase physical activity,” Michos told Endocrine Today. “Of note, we found that only 40% of our study population were achieving AHA-recommended levels of physical activity at baseline. There are now many studies that have shown higher levels of physical activity to be linked with lower rates of heart disease, stroke, cancers, diabetes, and many other chronic health conditions. We saw this in our study too — that those who were the most active had the lowest risk of atherosclerotic cardiovascular disease events over nearly 20 years of follow. We need to invest efforts as a society to encourage individuals to move more.”
Michos added that uncertainty remains regarding whether vitamin D supplementation can mitigate the risk for adverse health effects that are associated with vitamin D deficiency.
“Clinical trials of vitamin D supplementation are currently ongoing to address this question,” she said. – by Regina Schaffer
For more information:
Erin D. Michos, MD, MHS, FACC, FAHA , can be reached at the Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD 21205; email: edonnell@jhmi.edu.
Disclosure: The researchers report no relevant financial disclosures.