Physicians' Academy for Cardiovascular Education

Healthy food intake and high cardiorespiratory fitness both important to slow progression of CAC

Concomitant Associations of Healthy Food Intake and Cardiorespiratory Fitness with Coronary Artery Calcium

Literature - Gripeteg L, Arvidsson D, Johannesson E, et al. - Am J Cardiol 2018; published online ahead of print

Introduction and methods

Cardiorespiratory fitness (CRF) is one of the strongest predictors of CV disease and mortality, and in combination with a healthy diet, it may improve vascular health [1]. Total coronary artery calcium (CAC) is an established measure of the extent of coronary arteriosclerosis [2]. Studies investigating the associations between CRF, healthy diet and CAC, have yielded conflicting findings [3].

In this analysis of the Swedish CArdioPulmonary BioImage Study (SCAPIS), the concomitant association of CAC with a compound measure of a healthy food intake (HFI) and with CRF was investigated. SCAPIS is a national, prospective, observational study including 30,000 individuals aged 50-64 years [4].

A sample of 1,111 SCAPIS participants was randomly selected, and underwent extensive imaging, functional studies of the heart, lungs and metabolism. Participants also completed a questionnaire to collect information on lifestyle, living conditions, health, socioeconomic status, and performed a CRF test. In total, 706 participants had complete data for this analysis. Food intake was assessed with the web-based interactive food frequency questionnaire MiniMeal-Q [5]. A submaximal exercise test was performed to assess CRF. CAC was assessed based on international standards [6]. A large proportion of participants had a CAC score of zero (58%).

Main results


Healthy food intake was associated with having no CAC, and in combination with higher CRF, HFI was also associated with lower CAC levels. These results support the importance of concomitant maintenance of healthy diet and CRF in middle-aged men and women to counteract the development of CAC. These findings also suggest the importance of the healthy habits to different phases of CAC development; healthy food intake may protect from the development of CAC, while higher CRF may be required for protecting from further progression of CAC.


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