Prevalence of Subclinical Coronary Artery Disease in Masters Endurance Athletes With a Low Atherosclerotic Risk Profile.
Level 4 - case-series / case-control
Cross-sectional comparative case-control study
PubMed 28465287 · doi:10.1161/CIRCULATIONAHA.116.026964
What was done
Cross-sectional comparison of 152 masters endurance athletes (mean age 54.4 ± 8.5 years, 70% male, training duration 31 ± 12.6 years; 77% runners with median 13 marathons) and 92 controls of similar age, sex, and low Framingham 10-year coronary artery disease risk scores. Assessments included echocardiography, exercise stress testing, computerized tomographic coronary angiography, cardiovascular magnetic resonance imaging with late gadolinium enhancement, and 24-hour Holter monitoring.
What was found
Most athletes (60%) and controls (63%) had normal coronary artery calcium (CAC) scores. Male athletes had higher plaque prevalence than sedentary males (44.3% vs. 22.2%, P = 0.009). Only male athletes showed CAC ≥300 Agatston units (11.3%) and luminal stenosis ≥50% (7.5%). Male athletes had mostly calcific plaques (72.7%), whereas sedentary males had mostly mixed morphology plaques (61.5%). Training years was independently associated with CAC >70th percentile or stenosis ≥50% in male athletes (odds ratio 1.08, 95% CI 1.01-1.15, P = 0.016). Late gadolinium enhancement occurred in 14% of male athletes (15 athletes; 7 consistent with prior myocardial infarction) and 0% of controls.
Why it matters
Demonstrates that lifelong male endurance athletes with low conventional risk factors have higher coronary plaque burden and myocardial fibrosis than sedentary controls, but with predominantly calcified plaque morphology.
Limits
Cross-sectional design precludes causal inference and clinical outcome tracking. Findings are largely restricted to male athletes due to smaller female representation; the clinical prognosis of calcific plaques in athletes remains unmeasured.
Cited by
- supports A UK CT angiography study showed that male high-intensity, high-volume endurance athletes had more plaques and coronary calcium than non-athletes, but their plaques were almost exclusively calcified.
- supports In a UK CT angiography study of endurance athletes, female participants exhibited virtually no coronary calcium and no atherosclerosis.