Sex Differences in the Impact of Exercise Volume on Subclinical Coronary Atherosclerosis

Ahmed Abdelaziz, MD; Ahmed Elshahat, MD; Ahmed Farid Gadelmawla, MD; Muhammad Desouky, MD; Abdelrahman H. Hafez, MD; Mohamed Abdelaziz, MD; Noha Hammad, MD; Dua Eldosoky, MD; Kirtipal Bhatia, MD; Annalisa Filtz, MD; Daniel Lorenzatti, MD; Toshiki Kuno, MD, PhD; Salim S. Virani, MD, PhD; Martha Gulati, MD, MS; Michel D. Shapiro, DO, MCR; Carl J. Lavie, MD; Leandro Slipczuk, MD, PhD

doi:10.1016/j.jacadv.2025.101786

JACC: Advances (Jun 2025)

Sex Differences in the Impact of Exercise Volume on Subclinical Coronary Atherosclerosis

Ahmed Abdelaziz, MD,
Ahmed Elshahat, MD,
Ahmed Farid Gadelmawla, MD,
Muhammad Desouky, MD,
Abdelrahman H. Hafez, MD,
Mohamed Abdelaziz, MD,
Noha Hammad, MD,
Dua Eldosoky, MD,
Kirtipal Bhatia, MD,
Annalisa Filtz, MD,
Daniel Lorenzatti, MD,
Toshiki Kuno, MD, PhD,
Salim S. Virani, MD, PhD,
Martha Gulati, MD, MS,
Michel D. Shapiro, DO, MCR,
Carl J. Lavie, MD,
Leandro Slipczuk, MD, PhD

Affiliations

Ahmed Abdelaziz, MD: Medical Research Group of Egypt (MRGE), Negida Academy, Arlington, Massachusetts, USA; Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Ahmed Elshahat, MD: Medical Research Group of Egypt (MRGE), Negida Academy, Arlington, Massachusetts, USA; Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Ahmed Farid Gadelmawla, MD: Medical Research Group of Egypt (MRGE), Negida Academy, Arlington, Massachusetts, USA; Faculty of Medicine, Menoufia University, Menoufia, Egypt
Muhammad Desouky, MD: Medical Research Group of Egypt (MRGE), Negida Academy, Arlington, Massachusetts, USA; The Brooklyn Hospital Center, Brooklyn, New York, USA
Abdelrahman H. Hafez, MD: Medical Research Group of Egypt (MRGE), Negida Academy, Arlington, Massachusetts, USA; Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Mohamed Abdelaziz, MD: Medical Research Group of Egypt (MRGE), Negida Academy, Arlington, Massachusetts, USA; Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Noha Hammad, MD: Medical Research Group of Egypt (MRGE), Negida Academy, Arlington, Massachusetts, USA; Faculty of Medicine, Port-Said University, Port-Said, Egypt
Dua Eldosoky, MD: Medical Research Group of Egypt (MRGE), Negida Academy, Arlington, Massachusetts, USA; Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
Kirtipal Bhatia, MD: Division of Cardiology, Montefiore Health System/Albert Einstein College of Medicine, Bronx, New York, USA
Annalisa Filtz, MD: Division of Cardiology, Montefiore Health System/Albert Einstein College of Medicine, Bronx, New York, USA
Daniel Lorenzatti, MD: Division of Cardiology, Montefiore Health System/Albert Einstein College of Medicine, Bronx, New York, USA
Toshiki Kuno, MD, PhD: Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
Salim S. Virani, MD, PhD: Aga Khan University, Karachi, Pakistan
Martha Gulati, MD, MS: The Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA; Baim Institute for Clinical Research, Boston, Massachusetts, USA
Michel D. Shapiro, DO, MCR: Center for Prevention of Cardiovascular Disease, Section on Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
Carl J. Lavie, MD: Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the UQ School of Medicine, New Orleans, Louisiana, USA
Leandro Slipczuk, MD, PhD: Division of Cardiology, Montefiore Health System/Albert Einstein College of Medicine, Bronx, New York, USA; Address for correspondence: Dr Leandro Slipczuk, Division of Cardiology, Montefiore Health System/Albert Einstein College of Medicine, 111 E 210th Street, Bronx, New York 10467, USA.

DOI: https://doi.org/10.1016/j.jacadv.2025.101786
Journal volume & issue: Vol. 4, no. 6
p. 101786

Abstract

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Background: The effects of high-volume exercise on coronary atherosclerosis remain controversial. Objectives: The authors aimed to evaluate the impact of endurance exercise on coronary atherosclerosis assessed by cardiac computed tomography (CT) in athletes and nonathletes, and analyze differences based on sex. Methods: We searched PubMed, Scopus, Web of Science, and Cochrane Central for relevant studies from inception to September 2024, assessing the impact of different exercise volumes on subclinical coronary artery atherosclerosis assessed by coronary artery calcification (CAC) scoring or CT angiography (CCTA). The control group comprised nonathletes. The primary outcome was the difference in CAC scores between athletes and nonathletes and the secondary outcome was the differences in calcified plaque by CCTA. The analysis was stratified by sex and exercise volume assessed using metabolic equivalents of task (MET)-min/wk. Results: Nine observational studies including 61,150 participants were included in the analysis. Male athletes with an exercise volume of >3,000 MET-min/wk showed higher mean CAC scores than nonathlete males (mean difference = 31.62; 95% CI: 10.66-52.58; P 3,000 MET-min/wk) exhibited a higher burden of calcified plaque by CAC score than male nonathletes, while no such difference was observed in female athletes.

Published in JACC: Advances

ISSN: 2772-963X (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the circulatory (Cardiovascular) system; Medicine: Internal medicine: Medical emergencies. Critical care. Intensive care. First aid
Website: https://www.sciencedirect.com/journal/jacc-advances

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