Ahmed Merghani1, Viviana Maestrini1, Stefania Rosmini1, Andrew T Cox1, Harshil Dhutia1, Rachel Bastiaenan1, Sarojini David1, Tee Joo Yeo1, Rajay Narain1, Aneil Malhotra1, Michael Papadakis1, Mathew G Wilson1, Maite Tome1, Khaled AlFakih1, James C Moon1, Sanjay Sharma2. 1. From Cardiology Clinical and Academic Group, St Georges, University of London, UK (A.M., A.T.C., H.D., R.B., R.N., A.M., M.P., M.T., S.S.); The Barts Heart Centre, University College London, UK (V.M., J.C.M.); Department of Cardiovascular, Respiratory, Geriatric, Anesthesiologic, and Nephrologic Sciences, Sapienza University of Rome, Italy (V.M., K.A.); University Hospital Lewisham, London, UK (S.R., S.D.); National University Heart Centre, Singapore (T.J.Y.); and Orthopaedic and Sports Medicine Hospital, Aspetar, Qatar (M.G.W.). 2. From Cardiology Clinical and Academic Group, St Georges, University of London, UK (A.M., A.T.C., H.D., R.B., R.N., A.M., M.P., M.T., S.S.); The Barts Heart Centre, University College London, UK (V.M., J.C.M.); Department of Cardiovascular, Respiratory, Geriatric, Anesthesiologic, and Nephrologic Sciences, Sapienza University of Rome, Italy (V.M., K.A.); University Hospital Lewisham, London, UK (S.R., S.D.); National University Heart Centre, Singapore (T.J.Y.); and Orthopaedic and Sports Medicine Hospital, Aspetar, Qatar (M.G.W.). sasharma@sgul.ac.uk.
Abstract
BACKGROUND: Studies in middle-age and older (masters) athletes with atherosclerotic risk factors for coronary artery disease report higher coronary artery calcium (CAC) scores compared with sedentary individuals. Few studies have assessed the prevalence of coronary artery disease in masters athletes with a low atherosclerotic risk profile. METHODS: We assessed 152 masters athletes 54.4±8.5 years of age (70% male) and 92 controls of similar age, sex, and low Framingham 10-year coronary artery disease risk scores with an echocardiogram, exercise stress test, computerized tomographic coronary angiogram, and cardiovascular magnetic resonance imaging with late gadolinium enhancement and a 24-hour Holter. Athletes had participated in endurance exercise for an average of 31±12.6 years. The majority (77%) were runners, with a median of 13 marathon runs per athlete. RESULTS: Most athletes (60%) and controls (63%) had a normal CAC score. Male athletes had a higher prevalence of atherosclerotic plaques of any luminal irregularity (44.3% versus 22.2%; P=0.009) compared with sedentary males, and only male athletes showed a CAC ≥300 Agatston units (11.3%) and a luminal stenosis ≥50% (7.5%). Male athletes demonstrated predominantly calcific plaques (72.7%), whereas sedentary males showed predominantly mixed morphology plaques (61.5%). The number of years of training was the only independent variable associated with increased risk of CAC >70th percentile for age or luminal stenosis ≥50% in male athletes (odds ratio, 1.08; 95% confidence interval, 1.01-1.15; P=0.016); 15 (14%) male athletes but none of the controls revealed late gadolinium enhancement on cardiovascular magnetic resonance imaging. Of these athletes, 7 had a pattern consistent with previous myocardial infarction, including 3(42%) with a luminal stenosis ≥50% in the corresponding artery. CONCLUSIONS: Most lifelong masters endurance athletes with a low atherosclerotic risk profile have normal CAC scores. Male athletes are more likely to have a CAC score >300 Agatston units or coronary plaques compared with sedentary males with a similar risk profile. The significance of these observations is uncertain, but the predominantly calcific morphology of the plaques in athletes indicates potentially different pathophysiological mechanisms for plaque formation in athletic versus sedentary men. Coronary plaques are more abundant in athletes, whereas their stable nature could mitigate the risk of plaque rupture and acute myocardial infarction.
BACKGROUND: Studies in middle-age and older (masters) athletes with atherosclerotic risk factors for coronary artery disease report higher coronary artery calcium (CAC) scores compared with sedentary individuals. Few studies have assessed the prevalence of coronary artery disease in masters athletes with a low atherosclerotic risk profile. METHODS: We assessed 152 masters athletes 54.4±8.5 years of age (70% male) and 92 controls of similar age, sex, and low Framingham 10-year coronary artery disease risk scores with an echocardiogram, exercise stress test, computerized tomographic coronary angiogram, and cardiovascular magnetic resonance imaging with late gadolinium enhancement and a 24-hour Holter. Athletes had participated in endurance exercise for an average of 31±12.6 years. The majority (77%) were runners, with a median of 13 marathon runs per athlete. RESULTS: Most athletes (60%) and controls (63%) had a normal CAC score. Male athletes had a higher prevalence of atherosclerotic plaques of any luminal irregularity (44.3% versus 22.2%; P=0.009) compared with sedentary males, and only male athletes showed a CAC ≥300 Agatston units (11.3%) and a luminal stenosis ≥50% (7.5%). Male athletes demonstrated predominantly calcific plaques (72.7%), whereas sedentary males showed predominantly mixed morphology plaques (61.5%). The number of years of training was the only independent variable associated with increased risk of CAC >70th percentile for age or luminal stenosis ≥50% in male athletes (odds ratio, 1.08; 95% confidence interval, 1.01-1.15; P=0.016); 15 (14%) male athletes but none of the controls revealed late gadolinium enhancement on cardiovascular magnetic resonance imaging. Of these athletes, 7 had a pattern consistent with previous myocardial infarction, including 3(42%) with a luminal stenosis ≥50% in the corresponding artery. CONCLUSIONS: Most lifelong masters endurance athletes with a low atherosclerotic risk profile have normal CAC scores. Male athletes are more likely to have a CAC score >300 Agatston units or coronary plaques compared with sedentary males with a similar risk profile. The significance of these observations is uncertain, but the predominantly calcific morphology of the plaques in athletes indicates potentially different pathophysiological mechanisms for plaque formation in athletic versus sedentary men. Coronary plaques are more abundant in athletes, whereas their stable nature could mitigate the risk of plaque rupture and acute myocardial infarction.
Authors: Gherardo Finocchiaro; Harshil Dhutia; Belinda Gray; Bode Ensam; Stathis Papatheodorou; Chris Miles; Aneil Malhotra; Zeph Fanton; Paulo Bulleros; Tessa Homfray; Adam A Witney; Nicholas Bunce; Lisa J Anderson; James S Ware; Rajan Sharma; Maite Tome; Elijah R Behr; Mary N Sheppard; Michael Papadakis; Sanjay Sharma Journal: Europace Date: 2020-04-01 Impact factor: 5.214
Authors: Laura F DeFina; Nina B Radford; Carolyn E Barlow; Benjamin L Willis; David Leonard; William L Haskell; Stephen W Farrell; Andjelka Pavlovic; Katelyn Abel; Jarett D Berry; Amit Khera; Benjamin D Levine Journal: JAMA Cardiol Date: 2019-02-01 Impact factor: 14.676
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