Physical fitness in male adolescents and atherosclerosis in middle age: a population-based cohort study

Ángel Herraiz-Adillo; Viktor H Ahlqvist; Sara Higueras-Fresnillo; Kristofer Hedman; Emil Hagström; Melony Fortuin-de Smidt; Bledar Daka; Cecilia Lenander; Daniel Berglind; Carl Johan Östgren; Karin Rådholm; Francisco B Ortega; Pontus Henriksson

doi:10.1136/bjsports-2023-107663

Physical fitness in male adolescents and atherosclerosis in middle age: a population-based cohort study

Br J Sports Med. 2024 Feb 14;58(8):411-420. doi: 10.1136/bjsports-2023-107663. Online ahead of print.

Authors

Ángel Herraiz-Adillo¹, Viktor H Ahlqvist², Sara Higueras-Fresnillo^{1

3}, Kristofer Hedman⁴, Emil Hagström⁵, Melony Fortuin-de Smidt⁶, Bledar Daka⁷, Cecilia Lenander⁸, Daniel Berglind^{2

9}, Carl Johan Östgren^{1

10}, Karin Rådholm^{1

11}, Francisco B Ortega^{12

13}, Pontus Henriksson¹⁴

Affiliations

¹ Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
² Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
³ Department of Physical Education, Sport and Human Motricity, Universidad Autónoma de Madrid, Madrid, Spain.
⁴ Department of Clinical Physiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
⁵ Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden.
⁶ Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
⁷ School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden.
⁸ Department of Clinical Sciences in Malmö, Centre for Primary Health Care Research, Lund University, Lund, Sweden.
⁹ Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden.
¹⁰ Centre of Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.
¹¹ The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.
¹² Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS) and CIBEROBN Physiopathology of Obesity and Nutrition, University of Granada, Granada, Spain.
¹³ Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
¹⁴ Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden pontus.henriksson@liu.se.

Abstract

Objectives: To examine the associations between physical fitness in male adolescents and coronary and carotid atherosclerosis in middle age.

Methods: This population-based cohort study linked physical fitness data from the Swedish Military Conscription Register during adolescence to atherosclerosis data from the Swedish CArdioPulmonary bioImage Study in middle age. Cardiorespiratory fitness was assessed using a maximal cycle-ergometer test, and knee extension muscular strength was evaluated through an isometric dynamometer. Coronary atherosclerosis was evaluated via Coronary Computed Tomography Angiography (CCTA) stenosis and Coronary Artery Calcium (CAC) scores, while carotid plaques were evaluated by ultrasound. The associations were analysed using multinomial logistic regression, adjusted (marginal) prevalences and restricted cubic splines.

Results: The analysis included 8986 male adolescents (mean age 18.3 years) with a mean follow-up of 38.2 years. Physical fitness showed a reversed J-shaped association with CCTA stenosis and CAC, but no consistent association was observed for carotid plaques. After adjustments, compared with adolescents in the lowest tertile of cardiorespiratory fitness and muscular strength, those in the highest tertile had 22% (OR 0.78; 95% CI 0.61 to 0.99) and 26% (OR 0.74; 95% CI 0.58 to 0.93) lower ORs for severe (≥50%) coronary stenosis, respectively. The highest physical fitness group (high cardiorespiratory fitness and muscular strength) had 33% (OR 0.67; 95% CI 0.52 to 0.87) lower OR for severe coronary stenosis compared with those with the lowest physical fitness.

Conclusion: This study supports that a combination of high cardiorespiratory fitness and high muscular strength in adolescence is associated with lower coronary atherosclerosis, particularly severe coronary stenosis, almost 40 years later.

Keywords: Cardiovascular Diseases.