Endurance exercise and the risk of cardiovascular pathology in men: a comparison between lifelong and late-onset endurance training and a non-athletic lifestyle - rationale and design of the Master@Heart study, a prospective cohort trial

Abstract

IntroductionLow and moderate endurance exercise is associated with better control of cardiovascular risk factors, a decreased risk of coronary artery disease and atrial fibrillation (AF). There is, however, a growing proportion of individuals regularly performing strenuous and prolonged endurance exercise in which the health benefits have been challenged. Higher doses of endurance exercise have been associated with a greater coronary atherosclerotic plaque burden, risk of AF and myocardial fibrosis (MF).Methods and analysisMaster@Heart is a multicentre prospective cohort study aiming to assess the incidence of coronary atherosclerosis, AF and MF in lifelong endurance athletes compared to late-onset endurance athletes (initiation of regular endurance exercise after the age of 30 years) and healthy non-athletes.The primary endpoint is the incidence of mixed coronary plaques. Secondary endpoints include coronary calcium scores, coronary stenosis >50%, the prevalence of calcified and soft plaques and AF and MF presence. Tertiary endpoints include ventricular arrhythmias, left and right ventricular function at rest and during exercise, arterial stiffness and carotid artery intima media thickness.Two hundred male lifelong athletes, 200 late-onset athletes and 200 healthy non-athletes aged 45–70 will undergo comprehensive cardiovascular phenotyping using CT, coronary angiography, echocardiography, cardiac MRI, 12-lead ECG, exercise ECG and 24-hour Holter monitoring at baseline. Follow-up will include online tracking of sports activities, telephone calls to assess clinical events and a 7-day ECG recording after 1 year.Ethics and disseminationLocal ethics committees approved the Master@Heart study. The trial was launched on 18 October 2018, recruitment is complete and inclusions are ongoing.Trial registration numberNCT03711539.

Semiautomatic Training Load Determination in Endurance Athletes

“…Training data were collected from two international multicenter studies: the Prospective Athlete Heart study (Pro@Heart) and the Master Athlete's Heart study (Master@Heart;de Bosscher, Dausin, et al, 2022;de Bosscher et al, 2021). Pro@Heart is a prospective study in which young male and female endurance athletes (cycling, distance running [≥1,500 m], duathlon, triathlon, rowing, swimming [≥400 m], or cross-country skiing) competing at national or international level are recruited at a starting age between 16 and 23 years, with the aim to characterize cardiac remodeling during 20 years of follow-up (de Bosscher, Dausin, et al, 2022).…”

“…Pro@Heart is a prospective study in which young male and female endurance athletes (cycling, distance running [≥1,500 m], duathlon, triathlon, rowing, swimming [≥400 m], or cross-country skiing) competing at national or international level are recruited at a starting age between 16 and 23 years, with the aim to characterize cardiac remodeling during 20 years of follow-up (de Bosscher, Dausin, et al, 2022). Master@Heart is a cohort study including middle-aged men between 45 and 70 years participating in endurance sports, aiming to assess the impact of endurance sport on cardiac and vascular function (de Bosscher et al, 2021). For the current study, we included male athletes in whom ≥1 year of training data were available, of which at least 100 training sessions included HR monitoring.…”

“…All participants underwent an incremental cardiopulmonary exercise test on a cycle ergometer to assess peak oxygen consumption, including a 12-lead electrocardiogram (Avantronic Cylcus2, or Lode Excalibur Sport, Lode BV Medical Technology; de Bosscher, Dausin, et al, 2022;de Bosscher et al, 2021). The initial workload was set at 30 W or 60 W and increased by 30 W per minute until exhaustion.…”

“…The 22 participants from the Master@Heart study were asked to fill out a questionnaire on the type of sports, weekly training hours, and level of competition (Supplementary Material S6 [available online]; de Bosscher et al, 2021).…”

The electrocardiogram in athletes with left ventricular dilatation and reduced ejection fraction

“…The ongoing studies of master@heart and pro@heart aim to comprehensively phenotype, respectively, the older and the younger endurance athlete in prospective, longitudinal cohort studies. 12,13 Similarly, the SMART protocol (Selective Medical Advanced CaRdiovascular Topsports screening) and the coupled ELITE cohort (Evaluation of Lifetime participation in Intensive Top-level sports and Exercise), a collaborative initiative of the Dutch National Olympic Committee and the Dutch Sports Federation (NOC*NSF), the Netherlands Society of Cardiology Sports Section, and several Dutch academic and nonacademic hospitals, prospectively follows Dutch Olympic athletes, during and after their Olympic career. These initiatives include, among others, both extensive phenotyping (including repeated cardiac magnetic resonance imaging) and cardiogenetics.…”