Lifelong endurance exercise and its relation with coronary atherosclerosis.
Level 3 - non-randomized controlled study
Prospective observational comparative cohort study with cross-sectional imaging
PubMed 36881712 · doi:10.1093/eurheartj/ehad152
What was done
The Master@Heart prospective observational cohort study evaluated 191 lifelong master endurance athletes, 191 late-onset athletes who began endurance sports after age 30, and 176 healthy non-athletes. All participants were male with a low cardiovascular risk profile. Peak oxygen uptake was measured to quantify fitness. The primary endpoint was the prevalence of coronary plaques (calcified, mixed, and non-calcified) assessed by computed tomography coronary angiography, adjusted for multiple cardiovascular risk factors.
What was found
Median age was 55 (50-60) years in all groups. Peak oxygen uptake was higher in lifelong (159% [143-177%] predicted) and late-onset athletes (155% [138-169%] predicted) than in non-athletes (122% [108-138%] predicted). Compared to non-athletes, lifelong endurance sports participation was associated with higher odds of having at least one coronary plaque (OR 1.86, 95% CI 1.17-2.94), at least one proximal plaque (OR 1.96, 95% CI 1.24-3.11), at least one calcified plaque (OR 1.58, 95% CI 1.01-2.49), at least one calcified proximal plaque (OR 2.07, 95% CI 1.28-3.35), at least one non-calcified plaque (OR 1.95, 95% CI 1.12-3.40), at least one non-calcified proximal plaque (OR 2.80, 95% CI 1.39-5.65), and at least one mixed plaque (OR 1.78, 95% CI 1.06-2.99).
Why it matters
This study shows that lifelong endurance sports participation is associated with more coronary plaques, including non-calcified proximal plaques, rather than a more benign plaque phenotype compared to a healthy lifestyle.
Limits
The study included only male participants with low cardiovascular risk profiles, so findings may not generalize to women or higher-risk groups. The cross-sectional plaque assessment cannot establish causality or determine whether these plaques increase subsequent clinical cardiac events.
Cited by
- partial The Pro@Heart study demonstrated increased coronary plaque associated with high-intensity endurance activity in young and older elite athletes.