Coronary Atherosclerosis in Master Athletes: Current Knowledge and Future Challenges

Area of Science:

• Cardiovascular Medicine
• Sports Cardiology
• Exercise Physiology

Background:

• Regular exercise offers cardiovascular benefits, yet master athletes exhibit higher coronary plaque prevalence than non-athletes.
• This paradox is linked to sustained high shear stress, exercise-induced inflammation, calcium dysregulation, and genetic/lifestyle interactions.
• While often calcified, plaques in athletes can be mixed or non-calcified, posing long-term risk questions.

Purpose of the Study:

• To review current knowledge on coronary atherosclerosis in master athletes.
• To elucidate multifactorial mechanisms driving plaque development in this population.
• To discuss clinical implications, diagnostic approaches, and prevention strategies.

Main Methods:

• Literature review synthesizing current research on athlete coronary atherosclerosis.
• Analysis of mechanisms including vascular wall stress, inflammation, and calcium homeostasis.
• Evaluation of diagnostic tools like coronary calcium scoring and CT angiography.

Main Results:

• Master athletes present a higher prevalence of coronary atherosclerosis compared to sedentary individuals.
• Mechanisms involve sustained high shear stress, exercise-induced inflammation, and genetic factors.
• Plaque composition varies, with calcified, mixed, and non-calcified lesions observed.

Conclusions:

• Coronary atherosclerosis in master athletes is a complex issue requiring specialized assessment.
• Traditional cardiovascular risk scores may underestimate risk in athletic populations.
• Multimodal imaging and further research are crucial for accurate risk stratification and management.