Prevalence of Subclinical Coronary Artery Disease in Masters Endurance Athletes with a Low Atherosclerotic Risk Profile

Ahmed Merghani, Viviana Maestrini, Stefania Rosmini, Andrew T. Cox, Harshil Dhutia, Rachel Bastiaenan, Sarojini David, Tee Joo Yeo, Rajay Narain, Aneil Malhotra, Michael Papadakis, Mathew G. Wilson, Maite Tome, Khaled Alfakih, James C. Moon, Sanjay Sharma

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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.

Original languageEnglish
Pages (from-to)126-137
Number of pages12
JournalCirculation
Volume136
Issue number2
DOIs
Publication statusPublished - 11 Jul 2017
Externally publishedYes

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Athletes
Coronary Artery Disease
Coronary Vessels
Calcium
Pathologic Constriction
Gadolinium
Exercise Test
Myocardial Infarction
Magnetic Resonance Imaging
Atherosclerotic Plaques
Sports
Rupture
Angiography
Arteries

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Merghani, A., Maestrini, V., Rosmini, S., Cox, A. T., Dhutia, H., Bastiaenan, R., ... Sharma, S. (2017). Prevalence of Subclinical Coronary Artery Disease in Masters Endurance Athletes with a Low Atherosclerotic Risk Profile. Circulation, 136(2), 126-137. https://doi.org/10.1161/CIRCULATIONAHA.116.026964
Merghani, Ahmed ; Maestrini, Viviana ; Rosmini, Stefania ; Cox, Andrew T. ; Dhutia, Harshil ; Bastiaenan, Rachel ; David, Sarojini ; Yeo, Tee Joo ; Narain, Rajay ; Malhotra, Aneil ; Papadakis, Michael ; Wilson, Mathew G. ; Tome, Maite ; Alfakih, Khaled ; Moon, James C. ; Sharma, Sanjay. / Prevalence of Subclinical Coronary Artery Disease in Masters Endurance Athletes with a Low Atherosclerotic Risk Profile. In: Circulation. 2017 ; Vol. 136, No. 2. pp. 126-137.
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title = "Prevalence of Subclinical Coronary Artery Disease in Masters Endurance Athletes with a Low Atherosclerotic Risk Profile",
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.",
keywords = "coronary calcification, endurance exercise, masters athletes",
author = "Ahmed Merghani and Viviana Maestrini and Stefania Rosmini and Cox, {Andrew T.} and Harshil Dhutia and Rachel Bastiaenan and Sarojini David and Yeo, {Tee Joo} and Rajay Narain and Aneil Malhotra and Michael Papadakis and Wilson, {Mathew G.} and Maite Tome and Khaled Alfakih and Moon, {James C.} and Sanjay Sharma",
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Merghani, A, Maestrini, V, Rosmini, S, Cox, AT, Dhutia, H, Bastiaenan, R, David, S, Yeo, TJ, Narain, R, Malhotra, A, Papadakis, M, Wilson, MG, Tome, M, Alfakih, K, Moon, JC & Sharma, S 2017, 'Prevalence of Subclinical Coronary Artery Disease in Masters Endurance Athletes with a Low Atherosclerotic Risk Profile', Circulation, vol. 136, no. 2, pp. 126-137. https://doi.org/10.1161/CIRCULATIONAHA.116.026964

Prevalence of Subclinical Coronary Artery Disease in Masters Endurance Athletes with a Low Atherosclerotic Risk Profile. / Merghani, Ahmed; Maestrini, Viviana; Rosmini, Stefania; Cox, Andrew T.; Dhutia, Harshil; Bastiaenan, Rachel; David, Sarojini; Yeo, Tee Joo; Narain, Rajay; Malhotra, Aneil; Papadakis, Michael; Wilson, Mathew G.; Tome, Maite; Alfakih, Khaled; Moon, James C.; Sharma, Sanjay.

In: Circulation, Vol. 136, No. 2, 11.07.2017, p. 126-137.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Prevalence of Subclinical Coronary Artery Disease in Masters Endurance Athletes with a Low Atherosclerotic Risk Profile

AU - Merghani, Ahmed

AU - Maestrini, Viviana

AU - Rosmini, Stefania

AU - Cox, Andrew T.

AU - Dhutia, Harshil

AU - Bastiaenan, Rachel

AU - David, Sarojini

AU - Yeo, Tee Joo

AU - Narain, Rajay

AU - Malhotra, Aneil

AU - Papadakis, Michael

AU - Wilson, Mathew G.

AU - Tome, Maite

AU - Alfakih, Khaled

AU - Moon, James C.

AU - Sharma, Sanjay

PY - 2017/7/11

Y1 - 2017/7/11

N2 - 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.

AB - 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.

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KW - masters athletes

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