Male athletes who exercised more than 3,000 metabolic equivalents of task-minutes per week had a higher likelihood of experiencing subclinical coronary atherosclerosis, according to a study published June 4 in JACC: Advances.
One of the study’s authors, Leandro Slipczuk, MD, PhD, section head of clinical cardiology, director of advanced cardiac imaging and director of the Cardiovascular Atherosclerosis and Lipid Disorder Center at New York City-based Montefiore Einstein Health System, shared with Becker’s what cardiologists need to know about the study’s findings.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: What is one key takeaway physicians and cardiologists should know from this research?
Dr. Leandro Slipczuk: Our meta-analysis of nine studies involving 61,150 participants examined the association between exercise volume and the prevalence of subclinical coronary atherosclerosis.
We found that high-volume exercise (>3,000 MET-min/week) was associated with a greater burden of subclinical coronary atherosclerosis — measured by coronary artery calcium score and coronary CT angiography — in men, but not in women. 3,000 MET-min/week is often seen in recreational endurance athletes, competitive amateurs, and military trainees.
Q: Should there be a shift in clinical care guidelines based on this research? If so, what would that look like?
LS: While insufficient physical activity poses a far greater public health concern, there is growing attention to the potential risks associated with very high or extreme levels of exercise.
Our meta-analysis demonstrates that high-volume exercise (>3,000 MET-min/week) is associated with a greater burden of subclinical coronary artery disease in men but not in women, highlighting the need for tailored preventive care. Our study does not explore mechanistic pathways, and unmeasured confounding factors such as diet, alcohol, supplement use, inflammation, body composition and underlying risk profiles may have influenced the findings.
A key takeaway is that athletes are not immune to coronary artery disease. Although the overall risk of cardiovascular events has not been shown to increase with athletic activity, the potential for coronary artery disease should not be overlooked, as it remains the leading cause of sudden cardiac death in athletes over 35 years of age—commonly referred to as ‘Masters athletes’.
However, evidence consistently shows that individuals who maintain regular physical activity and good cardiorespiratory fitness experience more favorable outcomes — even in the presence of subclinical coronary atherosclerosis — compared to inactive individuals.
Furthermore, emerging data suggest that the intensity of physical activity, rather than total volume alone, may be a critical determinant of reduced mortality risk and improved longevity.
In addition, our approach grouping multiple different sports has significant limitations, as not all exercise is the same and measurements of volume/intensity across disciplines may not always be comparable.
Further research is needed to better characterize the effects of exercise on coronary atherosclerosis phenotypes — particularly non-calcified and low-attenuation plaque — and to elucidate the mechanisms underlying these unexpected cardiovascular adaptations.
Read the full study here.
