Coronary atherosclerosis in athletes: recent insights and clinical considerations

• Published in: British journal of sports medicine 2024-03, Vol.58 (11), p.574-576
• Main Authors: Aengevaeren, Vincent L, Claessen, Guido, Eijsvogels, Thijs MH
• Format: Article
• Language: English
• Subjects: Aspirin; Asymptomatic; Atherosclerosis; Athletes; Calcification; Cardiovascular disease; Cardiovascular Diseases; Coronary vessels; Editorial; Exercise; Fitness training programs; Heart; Ischemia; Longitudinal studies; Males; Medical imaging; Morphology; Physical fitness; Risk factors
• ISSN: 0306-3674; 1473-0480
• DOI: 10.1136/bjsports-2023-107938

Correspondence to Dr Thijs MH Eijsvogels, Department of Medical Biosciences, Radboud University Medical Center, Nijmegen, The Netherlands; [e-mail] Evidence from international cohort studies has shown increased coronary atherosclerosis in male athletes vs controls,1 whereas data for female athletes are scarce and contradictory but likely not different from controls.1 A larger lifelong exercise volume and greater proportion of very vigorous intensity exercise training were identified as independent predictors of the prevalence and progression of coronary artery calcification scores (CACS) in males.2–4 Early studies hypothesised that accelerated calcification may represent plaque stabilisation as less harmful plaque phenotypes (ie, more calcified and less mixed plaques) were found in athletes vs controls.3 4 However, this concept was challenged by the Master@Heart study as lifelong male endurance athletes had a similar plaque morphology compared with non-athletes.5 These collective findings raise questions whether athletes should be worried about the development of coronary atherosclerosis and its clinical sequelae. The good news Athletes have a better life expectancy compared with the general population with risk reductions for all-cause and cardiovascular mortality of ~30%–40%. [...]individuals with a higher cardiorespiratory fitness have a lower cardiovascular event rate for any given CACS compared with individuals with lower fitness.6 This may be partially attributable to a less harmful plaque composition. [...]plaque characteristics of the Master@Heart controls were comparable with the master athletes of the UK cohort3 and the most active group of the MARC study,4 suggesting that all participants of the Master@Heart study had predominantly favourable plaque morphology. Aspirin is ineffective for general primary prevention,13 but individuals with high CACS have cardiovascular risk equivalent to secondary prevention populations. [...]aspirin may be considered in individuals with high CACS, despite the lack of evidence supporting this approach.