Coronary atherosclerotic burden in veteran athletes: The relationship between cardiovascular risk and volume of exercise

Abstract

Introduction and objectives: The association between exercise and coronary atherosclerosis still remains unclarified. We aimed to analyze the prevalence of high coronary atherosclerotic burden in veteran athletes, considering cardiovascular (CV) risk and volume of exercise. Methods: A total of 105 asymptomatic male veteran athletes (48±5.6 years old) were studied. A high coronary atherosclerotic burden was defined as one of the following characteristics in coronary computed tomography angiography: calcium score >100, >75th percentile, obstructive plaques, involving left main, three-vessels or two-vessels including proximal anterior descending artery, segment involvement score >5 or CT-adapted Leaman score ≥5. CV risk was stratified by SCORE2 and volume of exercise by metabolic equivalent task score. Results: Most athletes (n=88) were engaged in endurance sports for 17.1±9.8 years, with a median exercise volume of 66 [IQR 44–103] metabolic equivalent of tasks/hour/week. The mean Systematic Coronary Risk Evaluation 2 was 2.8±1.5%; 76.9% of athletes had a low-moderate risk and none a very high risk. High coronary atherosclerotic burden was present in 25.7% athletes. Athletes with high cardiovascular risk and high exercise volume (above the median) showed significantly high coronary atherosclerotic burden compared to those with low-moderate risk and high volume (50.0% vs. 15.6%; p=0.017). Among athletes with low to moderate risk, a high volume of exercise tended to be protective, while in those with low volume, there was similar rate of high coronary atherosclerotic burden, regardless of CV risk. Conclusions: A combination of higher volume of exercise and high cardiovascular risk revealed the worst association with coronary atherosclerosis in veteran athletes. The relationship between these variables is controversial, but integrating exercise characteristics and risk assessment into preparticipation evaluation is essential. Resumo: Introdução e objetivos: A associação entre exercício e aterosclerose coronária permanece pouco esclarecida. O nosso objetivo foi analisar a prevalência de alta carga aterosclerótica coronária (CASC) em atletas veteranos, integrando o risco cardiovascular (RCV) e volume de exercício. Métodos: Avaliámos 105 atletas veteranos, homens assintomáticos (48±5,6 anos). Alta CASC foi definida como uma das: score de cálcio >100, >percentil 75, placas obstrutivas, envolvimento do tronco da artéria coronária esquerda, doença de 3 vasos ou 2 vasos incluindo artéria descendente anterior proximal, Segment Involvement Score >5 ou Score Leaman adaptado por CT ≥5. Estratificámos o RCV pelo SCORE2 e o volume de exercício por equivalentes metabólicos (METs). Resultados: A maioria dos atletas (n=88) praticava desportos de resistência, durante 17,1±9,8 anos, com um volume de exercício mediano de 66 [IQR 44-103] METs/hora/semana. O SCORE2 médio foi 2,8±1,5% e 76,9% dos atletas tinham RCV baixo-moderado e nenhum RCV muito-alto. Alta CASC ocorreu em 25,7%. Atletas com alto RCV e alto volume de exercício (acima da mediana) apresentaram CASC significativamente alta em comparação com os com RCV baixo-moderado e alto volume (50,0% versus 15,6%; p=0,017). Nos atletas com RCV baixo-moderado, o alto volume de exercício mostrou uma tendência protetora, enquanto houve uma taxa semelhante de alta CASC naqueles com baixo volume, independentemente do RCV. Conclusões: Em atletas veteranos, a combinação de maior volume de exercício com alto RCV mostrou a pior associação com aterosclerose coronária. A relação entre estas variáveis é controversa, mas integrar características do exercício e o RCV na avaliação pré-participação é essencial.

Keywords

• Atletas veteranos
• Risco cardiovascular
• SCORE2
• Doença coronária aterosclerótica
• Carga aterosclerótica coronária