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Exercise and Cardiovascular Response01:20

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Exercise significantly impacts cardiovascular response, which is crucial for understanding patient health and designing effective treatment plans.
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Coronary Artery Disease I: Introduction01:30

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Coronary Artery Disease (CAD): An Overview with Scientific InsightsCoronary Artery Disease (CAD), often referred to as C-A-D, is a prevalent blood vessel disorder classified under the broader category of atherosclerosis. Atherosclerosis is a pathological process characterized by the hardening and narrowing of arteries due to the accumulation of atherosclerotic plaques. These plaques are composed of cholesterol, fatty substances, inflammatory cells, calcium, and fibrin, reducing blood flow to...
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Coronary Artery Disease II: Pathophysiology01:26

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Coronary Artery Disease (CAD) originates from a series of events that impair the function of coronary arteries, the blood vessels responsible for delivering oxygen-rich blood to the heart muscle. The pathophysiology of CAD is closely linked to atherosclerosis, a chronic inflammatory and lipid-driven condition affecting the vascular endothelium.1. Endothelial DamageThe process begins with damage to the vascular endothelium, which serves as a protective barrier between the blood and the vessel...
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Atherosclerosis II: Clinical Manifestations and Diagnostic Tests01:27

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Atherosclerosis is a progressive disorder that leads to the thickening and narrowing of arterial walls due to plaque buildup. This condition can cause various symptoms depending on the arteries affected:Coronary Artery Disease (CAD): This condition affects the coronary arteries and may lead to chest pain (angina), shortness of breath (dyspnea), heart attacks, and other heart disease symptoms.Cerebrovascular Disease: This affects blood flow to the brain, causing transient ischemic attacks (TIAs)...
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Atherosclerosis III: Management01:26

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Management of atherosclerosis involves an integrated strategy encompassing pharmacological treatment, surgical interventions, lifestyle changes, and nutrition therapy to address the multifactorial nature of the disease.Pharmacological TherapyA cornerstone of atherosclerosis management is the use of pharmacological agents. Statins, such as atorvastatin, are pivotal in inhibiting HMG-CoA reductase, an enzyme that catalyzes an initial step in cholesterol synthesis in the liver. This reduction in...
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Coronary Artery Disease IV: Preventive Measures01:26

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Effective preventive measures for coronary artery disease (CAD) focus on controlling modifiable risk factors, including cholesterol abnormalities and lifestyle changes.Cholesterol ManagementFirst, the Mediterranean diet and the American Heart Association advocate for maintaining low-density lipoprotein (LDL) cholesterol levels below 100 mg/dL, with a more stringent recommendation of below 70 mg/dL for individuals at high risk. LDL cholesterol, often termed "bad cholesterol," can lead to the...
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Coronary Atherosclerosis in Master Athletes: Current Knowledge and Future Challenges.

Ioannis Boutsikos1, Themis Gkraikou2, Richard Saad3

  • 1Department of Therapeutics, Alexandra University Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece.

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Summary

Master athletes paradoxically show more coronary atherosclerosis despite exercise benefits. This review explores mechanisms, diagnosis, and prevention of plaque buildup in athletes, highlighting underestimation by traditional risk scores.

Keywords:
atherosclerosiscoronary calcium scoreelite athletesendurance exercisesports cardiology

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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.