# The influence of high exercise levels on the coronary atherosclerosis profile by computed tomography angiography and outcomes

## TL;DR

The study finds that high levels of exercise up to 9 hours per week do not harm coronary arteries or increase heart disease risk.

## Contribution

The study provides evidence that high exercise volumes are safe for coronary health, using coronary CTA and long-term outcomes.

## Key findings

- High-exercise levels up to 9 hours per week do not increase coronary stenosis severity or MACE rates.
- High-risk plaque frequency was lower in high-exercise groups, though not statistically significant after adjusting for CVRF.
- No significant differences in coronary artery calcium scores or CADRADS between high-exercise and sedentary groups.

## Abstract

High exercise volumes may have deleterious effects on the cardiovascular system, and the upper thresholds for "safe" volumes are unclear.

To evaluate if high-exercise volumes influence the coronary artery disease (CAD) profile by coronary CTA, cardiovascular outcomes, compared with traditional CVRF.

802 patients (age 57.6 ± 10.95 years;38.1 % women) undergoing coronary CTA were enrolled. Self-reported exercise habits were collected: Type, volume (frequency/week and time/per unit); and years of training. Endpoints were: CTA: coronary stenosis severity (CADRADS); high-risk-plaque (HRP); coronary artery calcium score (CAC), and MACE.

478 subjects were included. 100 with high-(H)-exercise level (>3–5x/week and 1–3 h per unit) were propensity-score matched with 124 sedentary controls. The CVRF dyslipidemia (p = 0.393) and age were similar in both groups (p = 0.328), while arterial hypertension (p = 0.016), diabetes (p = 0.032), and the BMI (p < 0.001) were lower in athletes. CAC (80.5 vs 107.7 AU: p = 0.820, CADRADS: p = 0.394) and MACE-rates were not different. Follow-up was 3.95±1.0 years. After matching for sex, HRP was 1.6-fold less frequent in the H-group (17 % vs 32.8 %; p = 0.231; OR 1.58 (95 % CI: 0.787–3.222) and smoking was more prevalent in controls. There was no difference in HRP after adjusting for all CVRF. MET was mean 8.78 ± 3.5; weekly training volume 9 h. The majority (78 %) reported >5 -10 years of training.

High-exercise levels (up to 9h/week) are safe - without a deleterious impact on the coronary atherosclerosis profile.