Paradoxical finding: Lifelong endurance exercise tied to more coronary atherosclerosis

The Master@Heart study showed that lifelong endurance athletes had more coronary plaques, including noncalcified ones, than healthy and fit people with a similarly low cardiovascular risk profile. The study was presented at the Scientific Sessions of ACC (American College of Cardiology)/WCC (World Congress of Cardiology) on March 6, 2023.

"Lifelong endurance sport participation is not linked to a more favourable coronary plaque composition versus a healthy lifestyle," the researchers wrote.

Considering the controversy on the impact of long-term endurance sport participation (with a healthy lifestyle) on acute cardiac events and coronary atherosclerosis, Ruben De Bosscher, Division of Cardiology, University Hospitals Leuven, Leuven, Belgium, and colleagues conducted the Master@Heart, a well-balanced prospective observational cohort study.

They addressed whether lifelong exercise results in less and more favourable plaque composition (i.e. lower prevalence of mixed and noncalcified plaques) to explain the presumably lower risk of cardiovascular events in individuals with high cardiorespiratory fitness.

The study included 191 late-onset athletes (endurance sports initiation after the age of 30 years), 191 lifelong master endurance athletes, and 176 healthy non-athletes, all males having a low CV risk profile. Fitness was quantified by VO2peak (peak oxygen uptake).

The prevalence of coronary plaques (noncalcified, mixed, and calcified) on computed tomography coronary angiography was determined (primary endpoint). Analyses were corrected for many CV risk factors.

The study led to the following findings:

• The median age was 55 years in all groups. Lifelong and late-onset athletes had higher VO2peak than non-athletes (159 vs 155 vs 122 % predicted).
• Lifelong endurance sports were associated with having ≥1 coronary plaque (odds ratio [OR] 1.86), ≥1 proximal plaque (OR 1.96), ≥1 calcified plaque (OR 1.58), ≥1 calcified proximal plaque (OR 2.07), ≥1 noncalcified plaque (OR 1.95), ≥1 noncalcified proximal plaque (OR 2.80) and ≥ one mixed plaque (OR 1.78) as compared to a healthy non-athletic lifestyle.

The findings showed that lifelong endurance sport participation does not lead to a favourable coronary plaque composition versus a healthy lifestyle.

"Lifelong endurance athletes had more coronary plaques (including more noncalcified plaques in proximal segments) compared to healthy and fit individuals with a similarly low CV risk profile," the researchers wrote.

"Longitudinal research is required to reconcile these findings with the risk of cardiovascular events at the higher end of the endurance exercise spectrum," they concluded.

Reference:

Ruben De Bosscher, MD, Christophe Dausin, MSc, Piet Claus, MSc PhD, Jan Bogaert, MD PhD, Steven Dymarkowski, MD PhD, Kaatje Goetschalckx, MD, Olivier Ghekiere, MD PhD, Caroline M Van De Heyning, MD PhD, Paul Van Herck, MD PhD, Bernard Paelinck, MD PhD, Haroun El Addouli, MD PhD, André La Gerche, MD PhD, Lieven Herbots, MD PhD, Rik Willems, MD PhD, Hein Heidbuchel, MD FESC FEHRA PhD, Guido Claessen, MD PhD, Master@Heart Consortium, Lifelong endurance exercise and its relation with coronary atherosclerosis, European Heart Journal, 2023;, ehad152, https://doi.org/10.1093/eurheartj/ehad152