Relationship Between Lifelong Exercise Volume and Coronary Atherosclerosis in Athletes.
Level 4 - case-series / case-control
Cross-sectional observational study with retrospective exposure recall
PubMed 28450347 · doi:10.1161/CIRCULATIONAHA.117.027834
What was done
Researchers evaluated 284 middle-aged men (mean age 55 ± 7 years) engaged in competitive or recreational sports. Participants underwent noncontrast and contrast-enhanced coronary computed tomography (CT) scans to measure coronary artery calcification (CAC) and evaluate plaque characteristics. Lifelong exercise history was self-reported, quantified into MET-minutes per week, and categorized into three exposure groups: <1000 MET-min/wk (n=88), 1000 to 2000 MET-min/wk, and >2000 MET-min/wk (n=75).
What was found
Overall, CAC was present in 53% of participants (150/284; median score 35.8, IQR 9.3–145.8). Men with >2000 MET-min/wk had higher CAC scores (median 9.4 vs 0, P=0.02), higher CAC prevalence (68% vs 43%; adjusted OR 3.2, 95% CI 1.6–6.6), and higher overall plaque prevalence (77% vs 56%; adjusted OR 3.3, 95% CI 1.6–7.1) compared to the <1000 MET-min/wk group. Very vigorous intensity exercise (≥9 MET) was associated with CAC (adjusted OR 1.47, 95% CI 1.14–1.91) and plaque (adjusted OR 1.56, 95% CI 1.17–2.08). However, among those with plaque, the >2000 MET-min/wk group had a lower prevalence of mixed plaques (48% vs 69%; adjusted OR 0.35, 95% CI 0.15–0.85) and a higher prevalence of purely calcified plaques (38% vs 16%; adjusted OR 3.57, 95% CI 1.28–9.97).
Why it matters
High lifelong exercise volume is associated with higher coronary plaque prevalence, but the plaques are predominantly calcified and stable rather than mixed. This benign plaque composition may help explain why high-volume endurance athletes retain overall cardiovascular longevity despite increased calcification.
Limits
The study is cross-sectional and included only middle-aged men, limiting generalizability to women. Lifelong exercise volume was based on retrospective self-report subject to recall bias, and the study did not track prospective clinical cardiovascular endpoints.
Cited by
- supports Individuals who engage in very high-intensity, very high-volume exercise over a lifetime are at elevated risk for cardiovascular issues such as atrial fibrillation and coronary calcification.