Long-Term Marathon Running Is Associated with Low Coronary Plaque Formation in Women

Roberts, William O.; Schwartz, Robert S.; Kraus, Sebastian; Schwartz, Jonathan; Peichel, Gretchen; Garberich, Ross; Lesser, John R.; Oesterle, Stephen N.; Wickstrom, Kelly; Knickelbine, Thomas; Harris, Kevin M.

doi:10.1249/mss.0000000000001154

Cited by 38 publications

(33 citation statements)

References 15 publications

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“…It is also conceivable that acutely high parathyroid hormone concentrations produced by exercise may accelerate coronary calcification in masters athletes. 32 The absence of increased CAD in female athletes has also been reported in a recent smaller study 27 and may be attributable to the protective effect of estrogens or the fact that atherosclerosis in general appears in females older than the female athletes assessed in this study. 33,34 Female athletes were 2 years younger than male athletes, whereas CAD generally occurs 10 years later in females compared with males.…”

Section: Possible Mechanisms For Increased Coronary Plaque Burden In supporting

confidence: 79%

Section: Discussionmentioning

confidence: 99%

“…The Fishers exact test and the χ-squared test were used to assess categorical data. Given prior reports of sex differences in the cardiac implications of exercise, 15,27,28 the cardiac CT, echocardiographic, and CMR data were analyzed in a sex-specific manner.Among masters athletes, univariable analyses were performed to identify variables associated with significant CAD (defined as a CAC score >70th percentile or a coronary luminal stenosis >50%), including age, family history of coronary artery disease in the 5th to 7th decades, total serum cholesterol, serum high-density lipoprotein, systolic blood pressure stratified by sex, and years of exercise. A multivariable logistic regression model was constructed retaining all variables associated with CAD in the univariable analyses, including an interaction variable (compound of age and years of training).…”

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confidence: 99%

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Prevalence of Subclinical Coronary Artery Disease in Masters Endurance Athletes With a Low Atherosclerotic Risk Profile

et al. 2017

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BACKGROUND: Studies in middle-age and older (masters) athletes with atherosclerotic risk factors for coronary artery disease report higher coronary artery calcium (CAC) scores compared with sedentary individuals. Few studies have assessed the prevalence of coronary artery disease in masters athletes with a low atherosclerotic risk profile. METHODS:We assessed 152 masters athletes 54.4±8.5 years of age (70% male) and 92 controls of similar age, sex, and low Framingham 10-year coronary artery disease risk scores with an echocardiogram, exercise stress test, computerized tomographic coronary angiogram, and cardiovascular magnetic resonance imaging with late gadolinium enhancement and a 24-hour Holter. Athletes had participated in endurance exercise for an average of 31±12.6 years. The majority (77%) were runners, with a median of 13 marathon runs per athlete. RESULTS:Most athletes (60%) and controls (63%) had a normal CAC score. Male athletes had a higher prevalence of atherosclerotic plaques of any luminal irregularity (44.3% versus 22.2%; P=0.009) compared with sedentary males, and only male athletes showed a CAC ≥300 Agatston units (11.3%) and a luminal stenosis ≥50% (7.5%). Male athletes demonstrated predominantly calcific plaques (72.7%), whereas sedentary males showed predominantly mixed morphology plaques (61.5%). The number of years of training was the only independent variable associated with increased risk of CAC >70th percentile for age or luminal stenosis ≥50% in male athletes (odds ratio, 1.08; 95% confidence interval, 1.01-1.15; P=0.016); 15 (14%) male athletes but none of the controls revealed late gadolinium enhancement on cardiovascular magnetic resonance imaging. Of these athletes, 7 had a pattern consistent with previous myocardial infarction, including 3(42%) with a luminal stenosis ≥50% in the corresponding artery. CONCLUSIONS:Most lifelong masters endurance athletes with a low atherosclerotic risk profile have normal CAC scores. Male athletes are more likely to have a CAC score >300 Agatston units or coronary plaques compared with sedentary males with a similar risk profile. The significance of these observations is uncertain, but the predominantly calcific morphology of the plaques in athletes indicates potentially different pathophysiological mechanisms for plaque formation in athletic versus sedentary men. Coronary plaques are more abundant in athletes, whereas their stable nature could mitigate the risk of plaque rupture and acute myocardial infarction. Prevalence of Subclinical Coronary Artery Disease in Masters Endurance Athletes With a Low Atherosclerotic Risk Profile© 2017 American Heart Association, Inc. ORIGINAL RESEARCH ARTICLE R egular exercise confers a low risk profile for atherosclerosis and is associated with a 50% reduction in adverse events from coronary artery disease (CAD).1,2 The amount of physical activity required to achieve these benefits is 150 minutes of moderate exercise per week. [3][4][5][6] In contrast, some athletes engage in several hours of intensive training p...

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Section: Possible Mechanisms For Increased Coronary Plaque Burden In supporting

confidence: 79%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Prevalence of Subclinical Coronary Artery Disease in Masters Endurance Athletes With a Low Atherosclerotic Risk Profile

et al. 2017

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“…Female athletes constituted only 30% of the overall population, and the prevalence of CAD or CAC score was similar in comparison with female controls. A comparison between sedentary middle-age women and women of similar age engaging in marathon running demonstrated a lower prevalence of coronary plaques and less calcified plaques in athletes, suggesting that the possible effects of long-term intense athletic training on coronary atherosclerosis may be different in men and women [ 66 •]. Further studies on larger cohorts are needed to clarify if female veteran athletes are less likely to develop coronary atherosclerosis.…”

Section: Veteran Female Athletesmentioning

confidence: 99%

The Female Athlete’s Heart: Facts and Fallacies

Colombo

Finocchiaro

2018

Curr Treat Options Cardio Med

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Purpose of the reviewFor many years, competitive sport has been dominated by men. Recent times have witnessed a significant increase in women participating in elite sports. As most studies investigated male athletes, with few reports on female counterparts, it is crucial to have a better understanding on physiological cardiac adaptation to exercise in female athletes, to distinguish normal phenotypes from potentially fatal cardiac diseases. This review reports on cardiac adaptation to exercise in females.Recent findingsRecent studies show that electrical, structural, and functional cardiac changes due to physiological adaptation to exercise differ in male and female athletes. Women tend to exhibit eccentric hypertrophy, and while concentric hypertrophy or concentric remodeling may be a normal finding in male athletes, it should be evaluated carefully in female athletes as it may be a sign of pathology. Although few studies on veteran female athletes are available, women seem to be affected by atrial fibrillation, coronary atherosclerosis, and myocardial fibrosis less than male counterparts.SummaryMales and females exhibit many biological, anatomical, and hormonal differences, and cardiac adaptation to exercise is no exception. The increasing participation of women in sports should stimulate the scientific community to develop large, longitudinal studies aimed at a better understanding of cardiac adaptation to exercise in female athletes.

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“…Of 1737 citations identified after searching MEDLINE, EMBASE, and Cochrane with the above search terms, 11 papers were selected for full‐text reading. References of these 11 manuscripts and the personal database of one author (SS) were reviewed for potentially relevant manuscripts, identifying another three articles, and yielding a total of 14 articles, which were included in the current review. A flow chart of study inclusions is provided in Appendix S1.…”

Section: Methodsmentioning

confidence: 99%

Cardiac imaging to detect coronary artery disease in athletes aged 35 years and older. A scoping review

Braber

Reitsma

Mosterd

et al. 2017

Scandinavian Med Sci Sports

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Sudden cardiac death (SCD) is a devastating event in athletes. Screening efforts that were first directed at athletes younger than 35 years are now focusing on the rapidly growing group of older sportspersons. Athletes aged ≥35 years have a 10-fold increased risk of exercise-related cardiac arrest, mostly due to coronary artery disease (CAD). Although cardiac imaging is pivotal in identifying CAD, the role of imaging modalities in screening asymptomatic older sportspersons remains unclear. We performed a scoping review to identify the role of cardiac imaging to detect CAD in older sportspersons and to identify gaps in the existing literature. We searched MEDLINE, EMBASE and the Cochrane library for studies reporting data on cardiac imaging of CAD in sportspersons ≥35 years. The systematic search yielded 1737 articles, and 14 were included in this scoping review. Imaging modalities included two echocardiography, one unenhanced computed tomography (CT) for coronary artery calcium scoring (CACS), three CACS and contrast-enhanced CT angiography (CCTA), two CACS and cardiac magnetic resonance (CMR), one CCTA with CMR and echocardiography, two CCTA, two CMR, and one myocardial perfusion imaging article. The low number of relevant articles and the selection bias introduced by studying specific groups, like veteran marathon runners, indicate the need for future research. Cardiac CT (CACS and CCTA) probably has the highest potential for pre-participation screening, with high diagnostic value to detect CAD and low radiation dose. However, currently there is insufficient evidence for incorporating routine cardiac imaging in the pre-participation screening of asymptomatic sportspersons over 35 years.

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Long-Term Marathon Running Is Associated with Low Coronary Plaque Formation in Women

Cited by 38 publications

References 15 publications

Prevalence of Subclinical Coronary Artery Disease in Masters Endurance Athletes With a Low Atherosclerotic Risk Profile

Prevalence of Subclinical Coronary Artery Disease in Masters Endurance Athletes With a Low Atherosclerotic Risk Profile

The Female Athlete’s Heart: Facts and Fallacies

Cardiac imaging to detect coronary artery disease in athletes aged 35 years and older. A scoping review

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