Lifelong endurance exercise and its relation with coronary atherosclerosis

Abstract

Background and Aims The impact of long-term endurance sport participation (on top of a healthy lifestyle) on coronary atherosclerosis and acute cardiac events remains controversial. Methods The Master@Heart study is a well-balanced prospective observational cohort study. Overall, 191 lifelong master endurance athletes, 191 late-onset athletes (endurance sports initiation after 30 years of age), and 176 healthy non-athletes, all male with a low cardiovascular risk profile, were included. Peak oxygen uptake (VO2peak) quantified fitness. The primary endpoint was the prevalence of coronary plaques (calcified, mixed, and non-calcified) on computed tomography coronary angiography. Analyses were corrected for multiple cardiovascular risk factors. Results The median age was 55 (50–60) years in all groups. Lifelong and late-onset athletes had higher VO2peak than non-athletes (159 [143-177] vs 155 [138-169] vs 122 [108-138] % predicted). Lifelong endurance sports was associated with having ≥1 coronary plaque (odds ratio [OR] 1.86, 95% confidence interval [CI] 1.17–2.94), ≥1 proximal plaque (OR 1.96, 95% CI 1.24–3.11), ≥1 calcified plaques (OR 1.58, 95% CI 1.01–2.49), ≥1 calcified proximal plaque (OR 2.07, 95% CI 1.28–3.35), ≥1 non-calcified plaque (OR 1.95, 95% CI 1.12–3.40), ≥1 non-calcified proximal plaque (OR 2.80, 95% CI 1.39–5.65) and ≥1 mixed plaque (OR 1.78, 95% CI 1.06–2.99) as compared to a healthy non-athletic lifestyle. Conclusion Lifelong endurance sport participation is not associated with a more favorable coronary plaque composition compared to a healthy lifestyle. Lifelong endurance athletes had more coronary plaques, including more non-calcified plaques in proximal segments, than fit and healthy individuals with a similarly low cardiovascular risk profile. Longitudinal research is needed to reconcile these findings with the risk of cardiovascular events at the higher end of the endurance exercise spectrum.

The VegPlate for Sports: A Plant-Based Food Guide for Athletes

“…In addition to satisfying the athlete’s nutritional needs and not interfering with sports performance, well-planned vegetarian diets (i.e., lacto-ovo and vegan) can be beneficial for the athlete’s health, potentially counteracting their higher risk of ischemic heart disease (IHD) [ 34 ]; the scientific literature reports that a vegetarian diet is associated with a reduction in the risk of IHD by 25% [ 92 ], and that, in general, the health benefits are greater in vegetarians than in nonvegetarians [ 93 ].…”

“…A 2009 German study had already found myocardial damage in 12% of a group of marathon runners over 50 years old, against 4% of controls chosen among sedentary peers [ 33 ]. A very recent study described that lifelong endurance athletes had more coronary plaques, including more noncalcified plaques in proximal segments, than fit and healthy individuals with a similarly low cardiovascular risk profile [ 34 ].…”

Nanomedomics

“…Atherosclerosis is a major contributor to heart attack and stroke. − Atherosclerotic plaque can upregulate antiphagocytic CD47 signaling, which would block immune clearance by macrophages through the CD47-SIRPα-SHP-1 signaling axis and facilitate sustained plaque expansion. − However, antibody-based systemic therapies that block CD47 signaling might exert adverse effects on healthy tissues, such as eliminating surrounding red blood cells to generate ischemia . Safety concerns have thus become a key barrier to the clinical translation of such drugs.…”

Prevalence of Coronary Atherosclerosis in Master Female Endurance Athletes

“…The benefits of exercise for curbing risk factors for atherosclerosis and reducing overall cardiovascular morbidity and mortality are widely recognized 1,2 , however, several studies have shown an increased burden of coronary atherosclerosis in male master athletes [3][4][5][6] . Whereas original studies reported increased coronary artery calcification (CAC) in male marathon runners with a relatively high prevalence of atherosclerotic risk factors 4 , recent studies have shown similar findings in male master athletes with a low atherosclerotic risk profile 3,5,6 .…”

“…The benefits of exercise for curbing risk factors for atherosclerosis and reducing overall cardiovascular morbidity and mortality are widely recognized 1,2 , however, several studies have shown an increased burden of coronary atherosclerosis in male master athletes [3][4][5][6] . Whereas original studies reported increased coronary artery calcification (CAC) in male marathon runners with a relatively high prevalence of atherosclerotic risk factors 4 , recent studies have shown similar findings in male master athletes with a low atherosclerotic risk profile 3,5,6 . Increasing age, traditional risk factors and volume of exercise are major determinants of high CAC scores in males although coronary inflammation, dietary factors, blood pressure responses to exercise and serum parathyroid hormone concentrations have also been postulated [7][8][9] .…”