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January 1, 2025Journal of Clinical CardiologyOpen Access

Athletes show paradoxically higher CAC and plaques than non-athletes but maintain favorable cardiovascular prognosis.

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Why the study?

Athletes may paradoxically show increased coronary artery calcium and high-risk plaque, but conflicting evidence and research gaps persist regarding the implications of coronary atherosclerosis in this growing population.

Does high-level physical activity increase coronary artery calcium and plaque burden in athletes compared to non-athletes?

Design

Review

Key result

Athletes exhibit a paradoxical increase in coronary artery calcium and coronary plaques compared to non-athletes, yet maintain a favorable cardiovascular prognosis.

Authors

MKMuneeb KhanKIKeishi IchikawaSKSrikanth Krishnan

Discussion

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Member takes

Overview

Supports cautious CAC interpretation in athletes to avoid overdiagnosis; leaves open prospective validation of risk models.

Structured PICO

Does high-level physical activity increase coronary artery calcium and plaque burden in athletes compared to non-athletes?

P
Population
A comprehensive review synthesizing current data on the prevalence, plaque morphology, and prognosis of coronary artery disease in athletes, particularly older Master Athletes.
E
Exposure
High-level physical activity and endurance sports
C
Comparator
Sedentary individuals or less active controls
O
Outcome
Prevalence and progression of coronary artery calcium (CAC) and plaque morphology assessed by Cardiac CTsurrogate

Athletes may exhibit a paradoxical increase in coronary artery calcium and plaque burden on cardiac CT, yet they maintain a lower risk of cardiovascular events, necessitating nuanced clinical management.

Limitations

  • Considerable conflicting evidence and numerous gaps in current research regarding the mechanisms of increased coronary atherosclerosis in athletes.
  • Limitations of CAC score calculation, as it may not always accurately represent plaque volume or stability.
  • Confounding risk factors in previous observational studies that could have influenced cardiovascular outcomes.
  • The optimal amount and safe threshold of exercise volume and intensity remain a topic of debate.
  • Unresolved questions about the exact nature of plaque development in athletes
  • Uncertainty regarding long-term effects on cardiovascular health
  • Lack of clarity on optimal exercise thresholds

Cite This Study

Khan et al. (2025) conducted a review in Coronary Artery Disease. High-level physical activity and endurance exercise vs. Sedentary lifestyle or non-athletes was evaluated. Athletes exhibit a paradoxical increase in coronary artery calcium and coronary plaques compared to non-athletes, yet maintain a favorable cardiovascular prognosis.

synapsesocial.com/papers/6a1f64e00a7b9a4ae2236045https://doi.org/10.33696/cardiology.6.064
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Coronary Atherosclerosis in Master Athletes: Current Knowledge and Future Challenges2026
  2. 2Coronary Artery Disease in Male Athletes—Is Sport Healthy in the Long Run?2026
  3. 3Exercise and Coronary Atherosclerosis2020 · 164 citations
  4. 4Coronary atherosclerosis in middle‐aged athletes: Current insights, burning questions, and future perspectives2020 · 21 citations
  5. 5Longitudinal insights into coronary plaque amongst master athletes2024 · 1 citations