Coronary atherosclerotic burden in master athletes: relationship with cardiovascular risk and volume of exercise

Abstract Background Although prior studies suggesting an association between coronary artery calcification (CAC) and lifelong exercise, the clinical relevance and mechanisms for this interaction remains unknown. Recent evidence suggests that a significant amount of exercise might not be linked to a more favourable composition of coronary plaques. We aimed to analyse the prevalence of high coronary atherosclerotic (CAS) burden assessed by coronary CT scan (CCTA) in master athletes, according to cardiovascular (CV) risk and volume of exercise. Methods A total of 105 master male athletes (48±5.6 years old), asymptomatic and without known CV disease, were prospectively studied. A high CAS burden was defined as the presence of at least one of the following characteristics in CCTA: CAC score >100; CAC score >75th percentile; obstructive plaques; plaques in the left main, three vessels or two vessels including the proximal anterior descending artery; segment Involvement Score (SIS) >5; CT-adapted Leaman score (CT-LeSc) ≥5T. his variable was evaluated according to the CV risk, stratified by SCORE2, and volume of exercise, determined by metabolic equivalent task score (MET/hour/week). Results Most athletes (n=88) were engaged in endurance sports, during 17.1±9.8 years, with a median exercise volume of 66 [IQR 44-103] METs/hour/week. The mean SCORE2 was 2.8±1.5%, with 76.9% of athletes classified as having a low to moderate CV risk, and none having very high-risk. A high CAS burden was present in 25.7% of the athletes, without significant differences according to the SCORE2 risk categories [Low- Moderate Vs. High Risk: 25.5% Vs. 37.5%, respectively ; p=0.142] nor volume of exercise [below Vs. above median: 30.6% Vs. 21.4%, respectively; p=0.283)] (Figure 1 A). Combining these variables, athletes with high CV risk and a high volume of exercise showed significantly higher occurrence of a high CAS burden compared to those with low-moderate risk and high volume of exercise (50% Vs. 15.6%; p=0.017). Among athletes with low-moderate risk, high volume of exercise trended to be protective (15.6% Vs. 31.4%; p=0,092), while there was a similar rate of high CAS burden in athletes with low volume of exercise, independently of risk class (Figure 1B). Conclusions In our cohort of master athletes, one fourth demonstrated a high burden of CAS burden evaluated by CCTA. While a higher volume of exercise combined with high cardiovascular risk showed an association with worse coronary composition it trended to be protective in athletes with lower risk. Integrating clinical and exercise-related data is crucial for evaluating athletes amidst the complex associations between exercise, cardiovascular risk, and CAS burden, necessitating longitudinal studies for comprehensive understanding.Figure 1Figure 2