Coronary Artery Disease in Male Athletes-Is Sport Healthy in the Long Run?

Physical activity wields a positive influence on atherosclerosis-related risk factors; however, the effects of high-intensity training on cardiovascular (CV) health are not unequivocal. The prevalence of coronary artery disease (CAD) in middle-aged sportsmen varies from 13.7% to 71%. Despite increased longevity and lower overall CV risk, CAD remains a serious problem in athletes, being responsible for the majority of sudden cardiac death (SCD) cases in sportsmen over 30 years. Endurance athletes engaging in high-intensity training are burdened with increased coronary artery calcification (CAC) of multifactorial pathophysiology, embracing i.a. wall shear stress, excessive reactive oxygen species, inflammatory mediators and increased levels of parathyroid hormone. Thanks to improved coronary vasodilatory capacity and coronary collateralization, sportsmen are rarely affected by hemodynamically significant coronary artery stenosis, and the atherosclerotic plaques are mostly of benign, calcified morphology. The basic screening should embrace medical history, CV risk assessment and rest electrocardiogram (ECG). Stress ECG tests, computed tomography (CT) with or without contrast, and functional imaging tests are additional diagnostic options. Because CAD in athletes remains a subject of research, the article aims at bringing closer the up-to-date findings on this matter, with a summary of diagnostic tools and clinical implications.