Exercise and Coronary Atherosclerosis: Observations, Explanations, Relevance, and Clinical Management

Area of Science:

• Cardiology
• Sports Medicine
• Preventive Cardiology

Background:

• Regular physical activity reduces cardiovascular disease risk.
• However, middle-aged and older athletes exhibit higher coronary atherosclerosis prevalence, often measured as coronary artery calcification.
• This finding contrasts with the general benefits of exercise.

Purpose of the Study:

• To review the effects of exercise on coronary atherosclerosis in middle-aged and older athletes.
• To understand potential adverse effects of high-volume exercise on coronary arteries.
• To guide clinical management of athletes with elevated coronary artery calcification.

Main Methods:

• Literature review of studies measuring coronary atherosclerosis using computed tomography (CT).
• Analysis of plaque morphology and composition in athletes versus controls.
• Examination of the association between exercise volume and coronary atherosclerosis.

Main Results:

• Athletes, especially highly active ones, have a higher prevalence of coronary artery calcification and atherosclerotic plaques compared to non-athletes.
• Plaque analysis in athletes suggests a more benign composition, with fewer mixed plaques and more calcified-only plaques.
• This indicates a potentially different disease process or progression in athletes.

Conclusions:

• While athletes may have more coronary calcification, the plaque characteristics suggest a potentially lower risk of acute cardiovascular events.
• Further research into the mechanisms and clinical relevance of exercise-induced coronary atherosclerosis is warranted.
• Physicians should consider plaque composition and clinical context when managing athletes with coronary artery calcification.