Decline in Physical Activity Precedes Cardiovascular Events

TOPLINE:

Moderate- to vigorous-intensity physical activity (MVPA) begins declining approximately 12 years before the onset of cardiovascular disease (CVD), with steeper drops 2 years before its onset. Black women consistently showed the lowest levels of MVPA and were at more than four times higher risk for low MVPA after a cardiovascular event than other groups.

METHODOLOGY:

• Researchers analyzed data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, a cohort of 3068 participants (mean age, 25.2 years) in four US cities from 1985-1986 through 2020-2022.
• Participants self-reported their levels of MVPA using a validated CARDIA physical activity history questionnaire, with scores measured in exercise units (300 units approximated 150 minutes of weekly MVPA).
• A nested case-control analysis examined 236 cases of CVD that occurred among participants in the study. Each incident was matched 1:1 with control group by age, sex, and race, focusing on MVPA trajectories before and after cardiovascular events.

TAKEAWAY:

• Levels of MVPA declined steadily from young adulthood into middle age before stabilizing, with Black men showing more sustained decline and Black women consistently reporting the lowest activity levels.
• The cases demonstrated accelerated declines in levels of MVPA within 2 years of a CVD event, with postevent gaps persisting compared with matched control group.
• Black women were at significantly elevated risk for low levels of MVPA after a CVD event compared with other groups (odds ratio [OR], 4.52; 95% CI, 2.29-8.89).
• After adjusting for levels of MVPA before a CVD event, cases were more likely than control group to have low levels of MVPA after the episode (OR, 1.78; 95% CI, 1.26-2.50).

IN PRACTICE:

“In this cohort and nested case-control study among CARDIA participants, MVPA declined from early adulthood to midlife then plateaued, with notable demographic differences; cases experienced steep declines before CVD, and gaps, compared to controls persisted afterward,” the researchers reported. “Black women had the lowest MVPA across adulthood and the highest risk of low MVPA post-CVD, underscoring the need to support lifelong physical activity and address group differences.”

SOURCE:

This study was led by Yariv Gerber, PhD, of the Department of Epidemiology and Preventive Medicine in the School of Public Health at Tel Aviv University, Israel. It was published online on July 23 in JAMA Cardiology.

LIMITATIONS:

According to the researchers, MVPA was self-reported, which could introduce potential misclassification bias. Study attrition over the follow-up period reduced the analytical sample size, and individuals with severe CVD may be underrepresented in postevent data. The relatively young CARDIA cohort yielded a modest number of CVD cases, limiting subgroup analyses. Data on cardiovascular disease severity, cardiac rehabilitation, and other potential influences on MVPA were unavailable.

DISCLOSURES:

The CARDIA study received support from the US National Heart, Lung, and Blood Institute in collaboration with multiple universities. Kelley Pettee Gabriel, PhD, disclosed receiving grants from the US National Institutes of Health during the conduct of the study. No other disclosures were reported.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.