Atherosclerosis with Plaque in Vessel


In the relentless pursuit of endurance, a stark revelation emerges: the bond between lifelong, high-intensity endurance exercise and coronary atherosclerosis is under scrutiny. Researchers have long been entranced by the intricate dance between enduring physical exertion and the heart's well-being. Initially, the narrative sang of endurance sports as a shield against the ravages of ischemic heart disease, a boon to those who embraced it.

Yet recent revelations strike a discordant note, painting a darker portrait. They unveil a surge in the prevalence of coronary atherosclerotic plaques among elite athletes, a shocking twist in the story. These studies uncover an essential nuance—an alteration in plaque composition. Athletes, it seems, harbor more stable calcified plaques.

Yet, a significant void remains unfilled: the absolute prevalence of calcified and non-calcified coronary plaques, an uncharted territory. Could it be that endurance athletes carry an equal or greater load of non-calcified and mixed plaques simply due to a higher overall plaque count?


Atherosclerosis with Plaque in Vessel close up shot


To unlock the mysteries at the zenith of the exercise-coronary artery disease continuum, we must venture deeper. While regular exercise undeniably sharpens the body's defenses—regulating blood pressure, sculpting lipid profiles, staving off diabetes and heart attacks, and bestowing the gift of longevity—it also unveils a perplexing contradiction. The paradox lies in the realm of heightened coronary atherosclerosis despite lower cardiovascular event rates.

Enter the "Master@Heart" study—a beacon of inquiry. It probes this very paradox, comparing the prevalence of coronary plaques—calcified, mixed, and non-calcified—among three cohorts: controls, late-blooming endurance athletes, and lifelong endurance athletes, all untarnished by established coronary artery disease risk factors.

The findings are striking. Lifelong endurance sports offer no additional shield against coronary atherosclerosis when juxtaposed with an active, health-conscious lifestyle. Astonishingly, middle-aged lifelong athletes bear the weight of more coronary plaques, notably the precarious non-calcified plaques residing in proximal segments.

These revelations challenge the hypothesis that highly trained endurance athletes harbor a benign plaque composition, potentially explaining their lower cardiovascular risk. Yet, the enigma persists, as research in the upper echelons of exercise impact remains scarce, casting shadows on the veracity of reduced coronary events in this high-end exercise cohort and the forces behind this paradox.

In a break from tradition, the "Master@Heart" study scrutinizes the absolute prevalence of various coronary plaque types. The results dispel the myth of a benign plaque composition in endurance athletes, whether lifelong or late-blooming. Instead, a dose-response relationship takes shape, with late-onset athletes perched between lifelong athletes and non-athletes.

Calcified plaques emerge as dominant players in both athlete and non-athlete realms, followed by mixed and non-calcified counterparts. Shockingly, a higher proportion of lifelong athletes harbor proximal plaques, lesions bearing significant stenosis, and plaques adorned with non-calcified and mixed traits. All these elements spell out the ominous signs of ischemic heart disease.

It's imperative to underscore that current evidence doesn't sing of heightened risk in endurance athletes when it comes to ischemic heart disease events. Some studies tout the protective mantle of endurance exercise, cutting across coronary artery calcium (CAC) scores, with the most profound armor reserved for higher CAC scores.

A labyrinth of factors potentially unravels this perplexing paradox. Vulnerable plaques, the harbingers of calamity, stand as rare apparitions in the realm of athletes, regardless of their athletic ardor. Moreover, endurance athletes boast wider coronary arteries and potent vasodilatory capabilities, possibly leading to a lesser plaque-to-vessel ratio and milder stenosis.

A pivotal discord with antecedent studies surfaces in the participants' training intensity and physical prowess. Athletes in the "Master@Heart" study eclipse their peers with more grueling training hours per week and loftier cardiorespiratory fitness levels. Even non-athletes in this study flaunt superior aerobic capacity.

The plot thickens—higher cardiorespiratory fitness levels hint at favorable plaque characteristics: reduced lipid volume, amplified fibrous volume, and reinforced fibrous caps. A startling hypothesis emerges—a reverse J-shaped correlation between endurance exercise and coronary atherosclerosis.

In essence, leading a health-driven life bolstered by above-average cardiorespiratory training and fitness prevents coronary atherosclerosis, adorning the canvas with a motif of calcified plaques and fewer mixed or non-calcified plaques. Ascending the ladder of endurance sports and fitness intensification does naught to alter the tapestry of plaque distribution.

As the quest for answers continues, the conundrum endures. The need for more longitudinal research at the apogee of endurance exercise looms large, a beacon guiding us through the labyrinthine depths of cardiovascular risk. Irrespective of one's journey on the endurance spectrum, there remains one steadfast ally in the pursuit of heart health: CoQ10. Its virtues await your discovery—explore them here.

James Freeman


Liam Marshall, the friendly fitness coach, has spent 14 years sharing his love for sports and fitness. With degrees in sports science, he crafts workouts that fit like your favorite jeans. Beyond the gym, he organizes sports clinics and tech-savvy fitness apps that motivate people worldwide. He's all about making fitness doable for everyone, and it's not just about bodies – it's boosting confidence. In 2019, he scored the "Virginia Fitness Coach of the Year" award. Outside the fitness world, he loves family time and hikes in Shenandoah National Park. Liam's journey from a small-town fitness fan to a big-time coach is all about passion, inspiring people to see fitness as a body-and-mind thing. Catch him on Instagram to stay in the loop!