High-Volume Exercise Linked to Higher Heart Disease Risk in Men, Not Women: Study

The study, led by Dr. Ahmed Abdelaziz from the Medical Research Group of Egypt (MRGE) and Negida Academy in Arlington, Massachusetts, and published in JACC: Advances, analyzed data from nine observational studies, including over 61,000 individuals. The goal was to investigate how varying levels of endurance exercise influenced subclinical coronary artery atherosclerosis and whether this impact differed between men and women.

Researchers performed a comprehensive search of medical databases, including PubMed, Scopus, Web of Science, and Cochrane Central, up to September 2024. The team focused on studies evaluating coronary artery disease markers, such as CAC scoring and CT coronary angiography (CCTA), in athletes compared to non-athletes. Exercise volume was quantified using metabolic equivalents of task (MET)-minutes per week, and the analysis was stratified by sex.

The key findings of the study were as follows:

• Male athletes performing high-intensity exercise exceeding 3,000 MET-min/week had significantly higher coronary artery calcium (CAC) scores than nonathletes (mean difference = 31.62).
• No significant difference in CAC scores was found among male athletes with moderate exercise levels (1,500–3,000 MET-min/wk) compared to non-athletes.
• Female athletes showed no significant differences in CAC scores regardless of whether they engaged in moderate or high-volume exercise.
• CT coronary angiography (CCTA) analysis revealed that male athletes with high-volume training had a greater burden of calcified plaque in addition to elevated CAC scores.
• Female athletes in the high-volume exercise group had fewer calcified plaques compared to non-athletes.
• Female athletes with moderate exercise levels had reduced plaque volumes compared to non-athletes.
• These findings suggest that the effect of exercise volume on coronary plaque burden differs between men and women.

The authors emphasized that these sex-specific trends suggest the need for tailored exercise recommendations. While exercise remains a cornerstone of cardiovascular health, the data indicate that higher training volumes might lead to increased subclinical coronary artery changes in men, potentially requiring closer monitoring.

However, limitations exist. The meta-analysis relied on observational studies, many of which lacked data on plaque composition and included limited racial diversity. These factors restrict the broad application of the findings and underline the necessity for future prospective research.

The study’s implications extend into clinical practice. The researchers note that given that standard cardiovascular risk assessment tools may not capture subclinical atherosclerosis in athletes, especially in men performing intense exercise, clinicians may need to re-evaluate how athletic individuals are screened and counseled.

"Long-term studies are warranted to clarify the link between subclinical plaque buildup, exercise habits, and eventual cardiovascular outcomes in both sexes," they concluded.

Reference:

Abdelaziz, A., Elshahat, A., Gadelmawla, A. F., Desouky, M., Hafez, A. H., Abdelaziz, M., Hammad, N., Eldosoky, D., Bhatia, K., Filtz, A., Lorenzatti, D., Kuno, T., Virani, S. S., Gulati, M., Shapiro, M. D., Lavie, C. J., & Slipczuk, L. (2025). Sex Differences in the Impact of Exercise Volume on Subclinical Coronary Atherosclerosis: A Meta-Analysis. JACC: Advances, 4(6), 101786. https://doi.org/10.1016/j.jacadv.2025.101786