Key result
Over 6 years of follow-up, cyclists had a significantly lower risk of developing coronary artery calcification compared with runners (adjusted OR 0.36; 95% CI 0.17-0.79; p=0.01).
Why the study?
Previous studies showing increased coronary atherosclerosis in amateur athletes were limited by cross-sectional designs and small sample sizes, preventing exploration of sport-specific associations.
Does cycling compared to running or other sports affect the incidence and progression of coronary artery calcification in asymptomatic middle-aged male amateur athletes?
Cohort (n=260)
Does cycling compared to running or other sports affect the incidence and progression of coronary artery calcification in asymptomatic middle-aged male amateur athletes?
Odds Ratio: 0.36 (95% CI 0.17–0.79)
p-value: p=0.01
Among middle-aged male amateur athletes, cyclists have a lower incidence and less progression of coronary artery calcification over 6 years compared to runners.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“What I think is very interesting is that in those who do very-vigorous-intensity exercise we found an increase in coronary artery calcification, but we also saw more calcified plaque progression. It's possible that we see increased plaque calcification that's also seen when individuals start with statins.”
“Of course, the key question is whether such progression is associated with events, which this small study can't tell us.”
“We are a little bit at odds with this discrepancy in findings, and physicians are often puzzled [with] what to do with these findings if they are encountered in clinical practice.”
Cycling was associated with less CAC progression than running in male athletes; leaves open causal effects and practice implications.
Background Emerging evidence indicates increased coronary atherosclerosis in amateur athletes. However, previous studies were limited by its cross-sectional design and limited sample size, preventing the exploration of sport specific associations with coronary atherosclerosis. Purpose We aimed to compare the incidence and progression of coronary artery calcification (CAC) between runners, cyclists and other types of athletes using a prospective cohort study with repetitive measurements. Methods Asymptomatic middle-aged men, who previously underwent a sports medical evaluation without abnormalities, were recruited in the Measuring Athlete's Risk of Cardiovascular events (MARC) study (n=318) and were asked to participate in this follow-up study. CT imaging was performed to assess CAC scores. Data was collected between 2012–2014 (i.e. baseline) and 2019–2020 (i.e. follow-up). We categorized participants as runners, cyclists or “other” sports (e.g. water polo, tennis, hockey, etc.) based on their dominant sport performance at baseline. Results We included 260 men in this interim analysis, with an average follow-up time of 6.3±0.5 years. Age (61.4±6.4 years), systolic blood pressure (143±20 mmHg), BMI (25.2±2.8 kg/m2), LDL-cholesterol (3.2±0.9 mmol/L), smoking (0.3 [0–8] pack years) and family history of coronary heart disease (28%) did not differ between runners (n=64), cyclists (n=75) and other athletes (n=121, all p>0.05). CAC was present in 137 (53%) men at baseline, which increased to 181 (70%) at follow-up. CAC scores increased from 1 [0–33] to 33 [0–129]. Cyclists had a lower CAC prevalence and CAC scores compared to individuals performing other sports at follow-up (Figure 1). Of those without CAC at baseline (n=123, 47%), cyclists less often developed CAC during follow-up compared with runners (adjusted OR=0.36 [0.17–0.79], p=0.01). In the entire cohort, CAC progression (ln delta CAC+1) was less prominent in cyclists than runners (adjusted B=−0.75 [−1.39 to −0.11], p=0.02), whereas progression of CAC in participants performing other sports did not differ from the runners. In participants with CAC at baseline, cyclists also had less CAC progression than runners (B=−0.49 [−0.95 to −0.02], p=0.04). Conclusion Cyclists have a lower incidence and less progression of CAC during 6 years of follow-up compared with runners and individuals performing other sports. Figure 1. Sport specific CAC prevalence and scores Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Hartstichting
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Aengevaeren et al. (2020) conducted a cohort in Coronary artery calcification (n=260). Cycling vs. Running and other sports was evaluated on Incidence of coronary artery calcification (OR 0.36, 95% CI 0.17-0.79, p=0.01). Over 6 years of follow-up, cyclists had a significantly lower risk of developing coronary artery calcification compared with runners (adjusted OR 0.36; 95% CI 0.17-0.79; p=0.01).
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