Exercise Volume vs. Intensity and Coronary Atherosclerosis Progression
- Exercise intensity, but not volume, was associated with progression of coronary atherosclerosis.
- While vigorous exercise was associated with less coronary artery calcification (CAC) progression, very vigorous exercise was associated with greater progression of CAC and mainly calcified plaque.
- Additional studies are indicated to investigate the CVD risk associated with CAC and coronary atherosclerosis in athletes and to assess the clinical implications of the greater progression of CAC with very vigorous exercise.
What is the longitudinal relationship between exercise training characteristics and coronary atherosclerosis?
The study investigators used coronary artery calcification (CAC) scoring and coronary computed tomography angiography (CCTA) to prospectively investigate the association between exercise volume and intensity and the progression of coronary atherosclerosis in a sizeable cohort of middle-aged and older male athletes. Middle-aged and older men from the MARC-1 (Measuring Athlete's Risk of Cardiovascular Events 1) study were invited for follow-up in the MARC-2 (Measuring Athlete's Risk of Cardiovascular Events 2) study. The prevalence and severity of CAC and plaques were determined by CCTA. The volume (metabolic equivalent of task [MET] hours/week) and intensity (moderate [3-6 MET hours/week]; vigorous [6-9 MET hours/week]; and very vigorous [≥9 MET hours/week]) of exercise training were quantified during follow-up. Linear and logistic regression analyses were performed to determine the association between exercise volume/intensity and markers of coronary atherosclerosis.
The study included 289 (age 54 [50-60] years [median, Q1-Q3]) of the original 318 MARC-1 participants with a follow-up of 6.3 ± 0.5 years (mean ± standard deviation). Participants exercised for 41 (25-57) MET hours/week during follow-up, of which 0% (0-19%) was at moderate intensity, 44% (0-84%) was at vigorous intensity, and 34% (0-80%) was at very vigorous intensity. Prevalence of CAC and the median CAC score increased from 52% to 71% and 1 (0-32) to 31 (0-132), respectively. Exercise volume during follow-up was not associated with changes in CAC or plaque. Vigorous-intensity exercise (per 10% increase) was associated with a lesser increase in CAC score (β, -0.05 [-0.09 to -0.01]; p = 0.02), whereas very vigorous intensity exercise was associated with a greater increase in CAC score (β, 0.05 [0.01-0.09] per 10%; p = 0.01). Very vigorous exercise was also associated with increased odds of dichotomized plaque progression (adjusted odds ratio [aOR], 1.09 [1.01-1.18] per 10% vs. 2.04 [0.93-4.15] for highest vs. lowest very vigorous intensity tertiles, respectively), and specifically with increased calcified plaques (aOR, 1.07 [1.00-1.15] per 10% vs. 2.09 [1.09-4.00] for highest vs. lowest tertile, respectively).
The authors report that exercise intensity, but not volume, was associated with progression of coronary atherosclerosis during 6-year follow-up.
This cohort study reports that exercise intensity, but not volume, was associated with progression of coronary atherosclerosis. While vigorous exercise was associated with less CAC progression, very vigorous exercise was associated with greater progression of CAC and mainly calcified plaque. It is possible that the acceleration in CAC attributed to very vigorous intensity exercise may reflect an increase in plaque calcification, but its clinical relevance remains unclear. Additional studies are indicated to investigate the cardiovascular disease (CVD) risk associated with CAC and coronary atherosclerosis in athletes and to assess the clinical implications of the greater progression of CAC with very vigorous exercise.
Clinical Topics: Cardiovascular Care Team, Diabetes and Cardiometabolic Disease, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Sports and Exercise Cardiology, Atherosclerotic Disease (CAD/PAD), Interventions and Coronary Artery Disease, Interventions and Imaging, Angiography, Computed Tomography, Nuclear Imaging, Exercise, Sports and Exercise and Imaging
Keywords: Atherosclerosis, Athletes, Calcinosis, Computed Tomography Angiography, Coronary Angiography, Coronary Artery Disease, Diagnostic Imaging, Exercise, High-Intensity Interval Training, Plaque, Atherosclerotic, Secondary Prevention
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