Improved Carotid Elasticity but Altered Central Hemodynamics and Carotid Structure in Young Athletes

Abstract

Young athletes most often exceed the physical activity recommendations of the World Health Organization. Therefore, they are of special interest for investigating cardiovascular adaptions to exercise. This study aimed to examine the arterial structure and function of young athletes 12–17 years old and compare these parameters to reference values of healthy cohorts. Carotid intima-media thickness (cIMT), carotid diameter, cIMT÷carotid diameter-ratio (cIDR), arterial compliance (AC), elastic modulus (Ep), β stiffness index (β), and carotid pulse wave velocity (PWVβ) were determined using ultrasound in 331 young athletes (77 girls; mean age, 14.6 ± 1.30 years). Central systolic blood pressure (cSBP) and aortic PWV (aPWV) were measured using the oscillometric device Mobil-O-Graph. Standard deviation scores (SDS) of all parameters were calculated according to German reference values. The 75th and 90th percentiles were defined as the threshold for elevated cIMT and arterial stiffness, respectively. Activity behavior was assessed with the MoMo physical activity questionnaire, and maximum power output with a standard cardiopulmonary exercise test. One-sample t-tests were performed to investigate the significant deviations in SDS values compared to the value “0”. All subjects participated in competitive sports for at least 6 h per week (565.6 ± 206.0 min/week). Of the 331 young athletes, 135 (40.2%) had cIMT >75th percentile, 71 (21.5%) had cSBP >90th percentile, and 94 (28.4%) had aPWV>90th percentile. We observed higher cIMT SDS (p < 0.001), cIDR SDS (p = 0.009), and AC SDS (p < 0.001) but lower β SDS (p < 0.001), Ep SDS (p < 0.001), and PWVβ SDS (p < 0.001) compared to the reference cohort. The cSBP SDS (p < 0.001) and aPWV SDS (p < 0.001) were elevated. In conclusion, cIMT and cIDR were higher in young athletes than in a reference cohort. Furthermore, young athletes presented better carotid elasticity and lower arterial stiffness of the carotid artery. However, central arterial stiffness was higher compared to the reference cohort. The thickening of the carotid intima-media complex in combination with a reduction in arterial stiffness indicates a physiological adaptation to exercise in youth.

Exercise Training Duration and Intensity Are Associated With Thicker Carotid Intima-Media Thickness but Improved Arterial Elasticity in Active Children and Adolescents

“…All measurements were conducted by two investigators. The analysis of the inter-observer variability revealed a small to acceptable deviation ( 11 ).…”

“…Recently, studies have also been performed in pediatric populations for the first time. A study observed better carotid elasticity but higher cIMT and cIMT÷carotid diameter-ratio (cIDR) and higher central arterial stiffness in young athletes ( 11 ). Another study found lower cIMT in male adolescent wrestlers than in controls, but there were no differences in cIMT and vascular function observed in young male athletes participating in dynamic or strength sports ( 12 , 13 ).…”

Impact of sports participation on cardiovascular health markers of children and adolescents: Systematic review and meta-analysis

“…Among adults, the literature recognizes that physical exercise improves the morphometry of arteries (arterial diameter increases improving dilation capacity which leads to reduced wall thickness)[ 27 ]. Thus, regular engagement in physical exercise is pointed out as effective in primary and secondary prevention strategies to reduce arterial wall thickness and arterial stiffness, especially in at-risk populations[ 27 , 28 ]. However, in our study with pediatric groups, both studies were carried out by the same research team and only cohort studies were found (no randomized clinical trials) which also limits further interpretations.…”