Key result
Athletic status in middle-aged men was not associated with differences in the prevalence of ≥1 carotid plaque compared to healthy controls (29.5% lifelong vs 33.2% late-onset vs 27.9% controls; p=0.54).
Why the study?
Middle-aged male Masters athletes exhibit higher coronary atherosclerosis on CCTA, but whether this is accompanied by differences in carotid atherosclerosis or aortic stiffness was uncertain.
Does endurance exercise in middle-aged male Masters athletes increase carotid atherosclerosis or aortic stiffness compared to healthy controls?
Cross-Sectional (n=549)
Does endurance exercise in middle-aged male Masters athletes increase carotid atherosclerosis or aortic stiffness compared to healthy controls?
Middle-aged male Masters athletes exhibit excess subclinical coronary atherosclerosis without corresponding differences in carotid plaque or aortic stiffness compared to healthy controls.
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Carotid plaque adds little to coronary risk discrimination in Masters athletes; leaves open whether vascular imaging refines athlete-specific prevention.
Background Middle-aged male Masters athletes exhibit a higher burden of coronary atherosclerosis on coronary computed tomography angiography (CCTA) compared with healthy controls. Whether this is accompanied by differences in carotid atherosclerosis or aortic stiffness remains uncertain. We assessed carotid atherosclerosis and aortic stiffness across groups, association between carotid atherosclerosis and coronary disease, and the incremental value of carotid plaque beyond traditional risk factors. Methods In this cross-sectional analysis of the Master@Heart study, 549 low cardiovascular risk men (median age 55 [50–60] years), including lifelong athletes, late-onset athletes, and healthy controls, underwent vascular phenotyping. Carotid plaque was assessed by ultrasound, aortic stiffness by carotid–femoral pulse wave velocity (PWV), and coronary atherosclerosis by CCTA. Group differences were assessed using chi-square and Kruskal–Wallis tests. Association between carotid and coronary atherosclerosis was evaluated using regression models. Incremental discriminatory value was assessed using ROC curve analysis. Results Prevalence of ≥1 carotid plaque did not differ between lifelong athletes, late-onset athletes, and controls (29.5% vs. 33.2% vs. 27.9%; p=0.54). Carotid stenosis ≥50% was rare (1.2%–2.7%) and similar across groups (p=0.54). Median PWV did not differ between groups (p=0.29). Carotid plaque was associated with coronary atherosclerosis on CCTA. However, adding carotid plaque to traditional risk factors did not improve discrimination of coronary atherosclerosis. Conclusion In middle-aged male Masters athletes, excess subclinical coronary atherosclerosis is observed without corresponding differences in carotid plaque or aortic stiffness. Although carotid plaque is associated with coronary atherosclerosis, it does not meaningfully improve risk discrimination beyond traditional risk factors.
Pauwels et al. (2026) conducted a cross-sectional in Low cardiovascular risk (n=549). Athletic training (lifelong or late-onset) vs. Healthy controls was evaluated on Prevalence of ≥1 carotid plaque (p=0.54). Athletic status in middle-aged men was not associated with differences in the prevalence of ≥1 carotid plaque compared to healthy controls (29.5% lifelong vs 33.2% late-onset vs 27.9% controls; p=0.54).
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