Ahmed Abdelaziz MD , Ahmed Elshahat MD , Ahmed Farid Gadelmawla MD , Muhammad Desouky MD , Abdelrahman H. Hafez MD , Mohamed Abdelaziz MD , Noha Hammad MD , Dua Eldosoky MD , Kirtipal Bhatia MD , Annalisa Filtz MD , Daniel Lorenzatti MD , Toshiki Kuno MD, PhD , Salim S. Virani MD, PhD , Martha Gulati MD, MS , Michel D. Shapiro DO, MCR , Carl J. Lavie MD , Leandro Slipczuk MD, PhD
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Abstract
Background
The effects of high-volume exercise on coronary atherosclerosis remain controversial.
Objectives
The authors aimed to evaluate the impact of endurance exercise on coronary atherosclerosis assessed by cardiac computed tomography (CT) in athletes and nonathletes, and analyze differences based on sex.
Methods
We searched PubMed, Scopus, Web of Science, and Cochrane Central for relevant studies from inception to September 2024, assessing the impact of different exercise volumes on subclinical coronary artery atherosclerosis assessed by coronary artery calcification (CAC) scoring or CT angiography (CCTA). The control group comprised nonathletes. The primary outcome was the difference in CAC scores between athletes and nonathletes and the secondary outcome was the differences in calcified plaque by CCTA. The analysis was stratified by sex and exercise volume assessed using metabolic equivalents of task (MET)-min/wk.
Results
Nine observational studies including 61,150 participants were included in the analysis. Male athletes with an exercise volume of >3,000 MET-min/wk showed higher mean CAC scores than nonathlete males (mean difference = 31.62; 95% CI: 10.66-52.58; P < 0.001), while no difference in CAC was found for male athletes with 1,500 to 3,000 MET-min/wk (P = 0.93) or female athletes with an exercise volume of 1,500 MET-min/wk or greater (P = 0.39 and P = 0.07). Our secondary endpoint showed significant sex-specific differences on the association of exercise volume and calcified plaque number and volume by CCTA.
Conclusions
Males with high-volume exercise training (>3,000 MET-min/wk) exhibited a higher burden of calcified plaque by CAC score than male nonathletes, while no such difference was observed in female athletes.
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