Better Late Than Never: Exercise as Primary and Secondary Prevention in CVD

CVD Risk and Young Adulthood

Much of the research into CVD risk and exercise has focused on middle-aged and older individuals leaving questions on the benefits of fitness during young adulthood over the long term.

Dr Shah and Venkatesh Murthy, MD, PhD, analyzed data from the prospective CARDIA study of adults aged 18 to 30 years who underwent treadmill testing at baseline and at 7 years. Participants had a median follow-up of 26.9 years to assess the incidence of CVD, obesity, coronary artery calcification, and left ventricular strain and mass.5

During the follow-up period, they observed 193 (4.0%) CVD events and 273 (5.6%) deaths, most of which were non-cardiac (73.3%).5 

They found that each additional minute of exercise test length at baseline was associated with a 12% decrease in HR for CVD (HR: 0.88; 95% CI: 0.81-0.96; P=.002) and a 15% decrease in HR for mortality (HR: 0.85; 95% CI: 0.80-0.91; P<.001), after adjusting for sex, age, race, obesity, and CVD risk factors.5 

Further, a 1-minute increase in exercise test length was associated with reduction in absolute LV mass (β= -0.24; 95% CI: -0.45 to -0.03; P=.02) and improvement in global longitudinal strain (β= -0.09; 95% CI: -0.14 to -0.05; P<.001).5

Repeat treadmill testing was conducted on 2472 participants 7 years later. The authors noted that for each minute of reduction in exercise test duration from baseline there was an associated increase in CVD (HR: 1.20; 95% CI: 1.06-1.37; P=.006), all-cause mortality (HR: 1.21; 95% CI: 1.07-1.37; P=.002), and global longitudinal strain (P<.001).5

“We found that the effects of exercise appear to be additive. We found that each additional minute of exercise capacity was associated with a 15% lower risk of death and a 12% lower risk of cardiovascular disease complications such as heart attacks,” Dr Murthy, of the cardiovascular medicine division at the University of Michigan in Ann Arbor, told Cardiology Advisor.

Exceeding Activity Expectations

Finally, at the annual AHA meeting, Chiadi Ndumele, MD, MHS, of Johns Hopkins School of Medicine, and colleagues presented data on patients from the ARIC study. They assessed the activity levels of the approximately 11 000 men and women aged 45 to 64 years twice during a 6-year period.

Participants who met or exceeded the AHA/ACC exercise recommendations at both assessments were 33% less likely to develop heart failure. Even modest exercise was associated with a 20% lower risk of heart failure. Furthermore, participants who were noted to be sedentary but increased activity to 4 sessions of 30 minutes of walking had a 12% decreased risk of heart failure.

In a meeting press release, Dr Ndumele stated, “Our findings suggest that when it comes to exercise and heart failure, the better-later-than-never axiom rings particularly true, and that even small boosts in activity can cut risk.”6


  1. Eijsvogels TM, Molossi S, Lee DC, Emery MS, Thompson PD. Exercise at the Extremes: The amount of exercise to reduce cardiovascular events. J Am Coll Cardiol. 2016;67(3):316-329.
  2. Heran BS, Chen JM, Ebrahim S, et al. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev. 2011;6(7): CD001800.
  3. Lawler PR, Filion KB, Eisenberg MJ. Efficacy of exercise-based cardiac rehabilitation post-myocardial infarction: a systematic review and meta-analysis of randomized controlled trials. Am Heart J. 2011;162(4):571-584.
  4. Taylor RS, Sagar VA, Davies EJ, et al. Exercise-based rehabilitation for heart failure. Cochrane Database Syst Rev. 2014;4:CD003331.
  5. Shah RV, Murthy VL, Colangelo LA, et al. Association of fitness in young adulthood with survival and cardiovascular risk: the Coronary Artery Risk Development in Young Adults (CARDIA) study. JAMA Intern Med. 2015;1-9.
  6. Study suggests starting exercise later in life reduces heart failure risk. Johns Hopkins News Tips from the American Heart Association Scientific Sessions [news release]. Baltimore, MD: Johns Hopkins Medicine News and Publications; November 11, 2015.
    _the_american_heart_association_scientific_sessions_nov_7_11_orlando_fla. Accessed February 1, 2016.