Exercise and Coronary Atherosclerosis

Abstract

Physical activity and exercise training are effective strategies for reducing the risk of cardiovascular events, but multiple studies have reported an increased prevalence of coronary atherosclerosis, usually measured as coronary artery calcification, among athletes who are middle-aged and older. Our review of the medical literature demonstrates that the prevalence of coronary artery calcification and atherosclerotic plaques, which are strong predictors for future cardiovascular morbidity and mortality, was higher in athletes compared with controls, and was higher in the most active athletes compared with less active athletes. However, analysis of plaque morphology revealed fewer mixed plaques and more often only calcified plaques among athletes, suggesting a more benign composition of atherosclerotic plaques. This review describes the effects of physical activity and exercise training on coronary atherosclerosis in athletes who are middle-aged and older and aims to contribute to the understanding of the potential adverse effects of the highest doses of exercise training on the coronary arteries. For this purpose, we will review the association between exercise and coronary atherosclerosis measured using computed tomography, discuss the potential underlying mechanisms for exercise-induced coronary atherosclerosis, determine the clinical relevance of coronary atherosclerosis in middle-aged athletes and describe strategies for the clinical management of athletes with coronary atherosclerosis to guide physicians in clinical decision making and treatment of athletes with elevated coronary artery calcification scores.

Physical activity and the progression of coronary artery calcification

“…25 In addition, other factors, such as diet, vitamins and minerals, may change with physical activity. 26 The second possibility is that physical activity may increase CAC scores without increasing CVD risk. The standard Agatston CAC scores are calculated as a combination of calcium density and the volume of plaque burden.…”

Implications of Carotid Arterial Plaque Assessment by Ultrasound for the Cardiothoracic Anesthesiologist: An Overview of the 2020 American Society of Echocardiography Recommendations for the Assessment of Carotid Arterial Plaque by Ultrasound for the Characterization of Atherosclerosis and Evaluation of Cardiovascular Risk

“…Intriguingly, despite some research showing a higher prevalence of atherosclerotic disease in athletes the overall cardiovascular risk for these patients has time and again been shown to be lower than in sedentary controls 4 . One hypothesis that may partially explain this phenomenon is that the athletes were more likely to have purely calcific plaques, suggestive that these lesions are more stable than mixed or noncalcific lesions and that plaque remodeling and ultimate composition may be an important driver of risk 4 .…”

There is urgent need to treat atherosclerotic cardiovascular disease risk earlier, more intensively, and with greater precision: A review of current practice and recommendations for improved effectiveness

“… Lifestyle [362] * Atherogenic diet (highly processed food, high salt and simple carbohydrates, poorly balanced nutrition) [363] , [364] , [365] , [366] ; saturated fat [367] , [368] , [369] , [370] ; trimethylamine-N-oxide (TMAO) [ 371 , 372 ]. Inadequate aerobic and resistance exercise [ 373 , 374 ]. Excess sedentary time independent of exercise [375] , [376] , [377] .…”