The ascending aorta and vascular profile in recreational masters runners: a cross-sectional study

Endurance exercise remodels the large arteries, but whether a recreational training dose is sufficient to induce such remodelling is unclear. Masters recreational runners over 40 years are under-represented in this research. We compared the ascending aortic diameter and vascular profile of these runners with sedentary controls of similar age.

This cross-sectional study included 42 masters recreational runners (at least 20 km per week for at least one year) and 27 sedentary controls, all over 40 years, free of cardiovascular disease and without bicuspid aortic valve or connective tissue disorder. We measured the ascending aortic diameter and left ventricular function by transthoracic echocardiography, and brachial-ankle pulse wave velocity (baPWV) and the ankle-brachial index (ABI) by oscillometry. Circulating collagen-turnover markers (CTX-I, MMP-2) were assayed. The aortic diameter was compared between groups by regression.

The ascending aorta was wider in runners (3.25 vs. 2.90 cm; p = 0.001; Cliff's delta 0.45). The difference persisted after adjustment for age, sex and height (beta 0.31 cm; p = 0.001) and in sensitivity analyses. No aortic diameter reached 4.0 cm; all remained within normal limits. The ABI was higher in runners (1.07 vs. 1.03; p = 0.007), and baPWV did not differ (p = 0.069); both stayed within normal limits. CTX-I and MMP-2 did not differ, and left ventricular function was preserved.

These findings are consistent with modest, exercise-associated aortic remodelling rather than overt aortopathy in recreational masters runners over 40 years.