Coronary Artery Calcification Among Endurance Athletes
“Hearts of Stone”
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Articles, see p 126 and p 138
…cause you’ll never break, never break, never break, this heart of stone.
—Mick Jagger and Keith Richards, The Rolling Stones, Heart of Stone, 1964
Routine moderate-intensity exercise reduces incident cardiovascular disease and increases longevity. The complex mechanisms by which exercise promotes favorable cardiovascular health outcomes include attenuation of traditional atherosclerotic risk factors including dyslipidemia, hypertension, central adiposity, and glucose intolerance. As such, current physical activity guidelines recommend either 150 minutes of moderate-intensity exercise or 75 minutes of higher-intensity exercise weekly.1 This recommendation is justified by a broad epidemiological and exercise intervention literature base and represents the current standard of cardiovascular care for all patients.2
However, the dose-response relationship between exercise and health outcomes, in particular, at exercise doses that exceed current recommendations, remains incompletely understood. For example, highly fit individuals have reduced risk of sudden cardiac death3 and development of heart failure,4 with little evidence of a plateau at high levels of fitness.5 Competitive athletes, people who in engage in very high levels of exercise over many years and in some cases a lifetime, typically live longer than sedentary and normally active people,6 and develop beneficial adaptive cardiovascular traits including physiological myocardial remodeling7,8 and increased myocardial9,10 and vascular compliance. Conversely, athletes and highly active people are not immune to cardiovascular disease. Sudden cardiac death certainly occurs among this population, and atherosclerotic coronary disease is the most common etiology of death during sport among those >35 years of age.11,12 Recent data have unexpectedly raised the possibility that long-term, high-volume endurance exercise may actually accelerate rather than reduce coronary atherosclerosis.13 This controversial hypothesis has been passionately debated and remains a key …