Relationship between aerobic fitness and progression of coronary atherosclerosis

Cross-sectional data suggest that the degree of coronary atherosclerosis is associated with aerobic fitness. However, there are limited longitudinal data addressing whether aerobic fitness is a predictor of coronary atherosclerosis progression. This study investigated whether peak oxygen consumption is related to a longitudinal increase in coronary calcium scores. Study subjects were voluntary participants in a health screening program who underwent a cardiopulmonary function test and repeated coronary calcium scoring. Individuals with clinical cardiovascular disease were excluded. The final sample included 4843 subjects with 14,856 records. The treadmill exercise test was performed using a modified Bruce protocol and Agatston coronary artery calcium (CAC) scores were measured using multi-detector CT. The mean age of the participants was 52 ± 6 years and 4.7 % were female. In a multi-level mixed effect regression model, increased CAC scores over time were significantly less likely in individuals with a higher VO₂peak after adjusting for age, gender, hypertension, HbA1c, smoking status and LDL cholesterol levels (p < 0.001). Aerobic fitness has a protective effect on the progression of coronary atherosclerosis in an asymptomatic middle-aged population.