Prevalence of Coronary Atherosclerosis in Master Female Endurance Athletes

BACKGROUND Studies in ostensibly healthy male master athletes have revealed a greater prevalence of coronary artery calcification (CAC) and coronary plaques compared with relatively sedentary counterparts. In contrast, data relating to potentially adverse coronary remodelling in female master athletes is sparse and conflicting. We investigated the prevalence of coronary atherosclerosis in a cohort of predominantly post-menopausal female master athletes with a low atherosclerotic risk profile. METHODS 196 female athletes with a mean age of 55±7 years-old and median exercise duration of 33 years (25-39) and 59 relatively sedentary females of similar age underwent cardiovascular investigations including a coronary computed tomogram angiography with assessment of CAC scores, coronary plaques, and pericoronary adipose tissue attenuation. 70% of the athletes and 68% of the control group were post-menopausal. RESULTS Athletes and controls had a similarly low Framingham 10-year risk (1.49% versus 2.1%; P=0.68), but body mass index and blood pressure were lower and HDL-C was higher in the athletes. The prevalence of CAC score >0 Agatston units (AU) was low and did not differ between athletes and controls (21% versus 32%;P=0.073). Female athletes had a lower prevalence of a CAC score >50 th centile (19% versus 32%;P<0.03) and >75 th centile (14% versus 25%;P=0.045) for age compared with controls, but the prevalence of a CAC score >100 AU did not differ between the groups (3.6% versus 8.5%;P=0.12). There were also no differences between the groups in the prevalence of individuals with coronary plaques (21% versus 32%;P=0.09), total plaque volume (16 mm 3 [IQR 3-56] versus 49 [5-142] mm 3 ;P=0.08), or plaque burden (10.8% [2.8-21] versus 15.4% [4.6-28];P=0.46). Coronary plaques were predominantly calcified in both athletes and controls (80% versus 63%;P=0.08). Age, blood pressure and HDL-C were independent predictors for a CAC score >0 AU among athletes. CONCLUSIONS In contrast with previous studies in male master athletes, lifelong exercise in female counterparts does not appear to be associated with increased CAC score, coronary plaque burden or any qualitative differences in coronary plaque compared with relatively sedentary healthy counterparts. Coronary atherosclerosis in master female athletes is mainly driven by traditional risk factors.