Prevalence of subclinical coronary artery disease in masters endurance athletes with a low atherosclerotic risk profile
Open accessAbstract
Background: Studies in middle-age and older (masters) athletes with atherosclerotic risk factors for coronary artery disease report higher coronary artery calcium (CAC) scores compared with sedentary individuals. Few studies have assessed the prevalence of coronary artery disease in masters athletes with a low atherosclerotic risk profile. Methods: We assessed 152 masters athletes 54.4±8.5 years of age (70% male) and 92 controls of similar age, sex, and low Framingham 10-year coronary artery disease risk scores with an echocardiogram, exercise stress test, computerized tomographic coronary angiogram, and cardiovascular magnetic resonance imaging with late gadolinium enhancement and a 24-hour Holter. Athletes had participated in endurance exercise for an average of 31±12.6 years. The majority (77%) were runners, with a median of 13 marathon runs per athlete. Results: Most athletes (60%) and controls (63%) had a normal CAC score. Male athletes had a higher prevalence of atherosclerotic plaques of any luminal irregularity (44.3% versus 22.2%; P =0.009) compared with sedentary males, and only male athletes showed a CAC ≥300 Agatston units (11.3%) and a luminal stenosis ≥50% (7.5%). Male athletes demonstrated predominantly calcific plaques (72.7%), whereas sedentary males showed predominantly mixed morphology plaques (61.5%). The number of years of training was the only independent variable associated with increased risk of CAC >70th percentile for age or luminal stenosis ≥50% in male athletes (odds ratio, 1.08; 95% confidence interval, 1.01–1.15; P =0.016); 15 (14%) male athletes but none of the controls revealed late gadolinium enhancement on cardiovascular magnetic resonance imaging. Of these athletes, 7 had a pattern consistent with previous myocardial infarction, including 3(42%) with a luminal stenosis ≥50% in the corresponding artery. Conclusions: Most lifelong masters endurance athletes with a low atherosclerotic risk profile have normal CAC scores. Male athletes are more likely to have a CAC score >300 Agatston units or coronary plaques compared with sedentary males with a similar risk profile. The significance of these observations is uncertain, but the predominantly calcific morphology of the plaques in athletes indicates potentially different pathophysiological mechanisms for plaque formation in athletic versus sedentary men. Coronary plaques are more abundant in athletes, whereas their stable nature could mitigate the risk of plaque rupture and acute myocardial infarction.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Prior studies only looked at the relative distribution of plaque type in individuals with evidence of plaque, but did not report differences in the absolute prevalence of calcified, mixed, and non-calcified plaques.
“these prior studies only looked at the relative distribution of plaque type in individuals with evidence of plaque, but differences in the absolute prevalence of calcified, mixed, and non-calcified plaques were not reported.”
From Lifelong endurance exercise and its relation with coronary atherosclerosis (2023) · cites this paper as [3]
In 2017, two other studies reported that athletes presenting with coronary plaques were more likely to have calcified plaques, whereas non-athletes with plaques more frequently had mixed plaques.
“In 2017, two other studies added a relevant nuance that athletes presenting with coronary plaques were more likely to have calcified plaques, whereas non-athletes with plaques more frequently had mixed plaques.3,4”
From Lifelong endurance exercise and its relation with coronary atherosclerosis (2023) · cites this paper as [3]
Non-athletes in Master@Heart exhibited a higher METmin/week than controls by Aengevaeren et al. (888 vs. 669 METmin/week) and a greater average percentage predicted VO2peak of 122% compared to 96% reported by Merghani et al.
“our non-athletes exhibited a higher level of fitness with a higher METmin/week than the controls by Aengevaeren et al. (888 vs. 669 METmin/week) and a greater average percentage predicted VO2peak of 122% compared to 96% reported by Merghani et al.3,4”
From Lifelong endurance exercise and its relation with coronary atherosclerosis (2023) · cites this paper as [3]
A lower prevalence of cardiac risk factors with low physical activity levels is associated with reduced coronary atherosclerosis but unfavourable plaque characteristics.
“a lower prevalence of cardiac risk factors with low physical activity levels is associated with reduced coronary atherosclerosis but unfavourable plaque characteristics.3,4”
From Lifelong endurance exercise and its relation with coronary atherosclerosis (2023) · cites this paper as [3]
The final sample size of Master@Heart remains twice as large as that of previous studies.
“the final sample size of the Master@Heart study remains twice as large as that of previous studies.2–4”
From Lifelong endurance exercise and its relation with coronary atherosclerosis (2023) · cites this paper as [3]
In Merghani et al. and Molhenkamp et al., athletes were mostly engaged in running, whilst the athletic population in Aengevaeren et al. was more diverse with 29% cyclists and 25% runners.
“In the paper by Merghani et al. and Molhenkamp et al., athletes were mostly engaged in running whilst the athletic population in the trial by Aengevaeren et al. was more diverse with 29% cyclists and 25% runners.2–4”
From Lifelong endurance exercise and its relation with coronary atherosclerosis (2023) · cites this paper as [3]
The analysis supports a reversed J-shaped association between exercise dose and CAD, with moderate physical activity offering cardiovascular protection and excessive endurance training possibly increasing atherosclerotic burden.
“Our analysis supports the hypothesis of a reversed J-shaped association between exercise dose and CAD as moderate physical activity offers cardiovascular protection, whereas excessive endurance training may increase atherosclerotic burden.6,7,9,12”
Middle-aged and older endurance athletes have increased prevalence of coronary artery disease on coronary computed tomography angiography compared with healthy controls, despite similarly low cardiovascular risk.
“Middle-aged and older endurance athletes have increased prevalence of coronary artery disease (CAD) on coronary computed tomography angiography compared with healthy controls, despite similarly low cardiovascular risk.”
Male masters endurance athletes with seemingly low cardiovascular disease risk have shown an increased prevalence of high coronary artery calcium scores and a greater number of coronary plaques compared with relatively sedentary counterparts of similar age.
“However, male masters endurance athletes with seemingly low cardiovascular disease risk have shown an increased prevalence of high coronary artery calcium (CAC) scores and a greater number of coronary plaques compared with relatively sedentary counterparts of similar age.2–5”
From Resting and exercise-induced occult hypertension and coronary atherosclerosis in male masters endurance athletes (2026) · cites this paper as [4]
The study was powered based on an assumed prevalence of significant coronary artery calcium ≥100 Agatston units of approximately 18.8% in this population.
“This prospective observational study was powered based on the assumption that the prevalence of significant CAC ≥100 AU in this population is approximately 18.8%.2 4”
From Resting and exercise-induced occult hypertension and coronary atherosclerosis in male masters endurance athletes (2026) · cites this paper as [4]
Male masters athletes exhibit higher CAC scores and greater prevalence of coronary atherosclerosis on CCTA compared with age and atherosclerotic risk-matched controls.
“growing evidence suggests that male masters athletes exhibit higher CAC scores and greater prevalence of coronary atherosclerosis on CCTA compared with age and atherosclerotic risk-matched controls.4 20”
From Resting and exercise-induced occult hypertension and coronary atherosclerosis in male masters endurance athletes (2026) · cites this paper as [4]
Athletes with plaque were more likely to have calcified plaque, while non-athletes tended to have mixed plaques more frequently.
“Two studies reported that athletes with plaque were more likely to have calcified plaque, while non-athletes tended to have mixed plaques more frequently.2 4”
From Resting and exercise-induced occult hypertension and coronary atherosclerosis in male masters endurance athletes (2026) · cites this paper as [4]
The prevalence of myocardial fibrosis in VENTOUX was higher than previously reported, including studies that also excluded right ventricular insertion point late gadolinium enhancement from the definition of left ventricular fibrosis.
“The prevalence of myocardial fibrosis in VENTOUX (VENTricular arrhythmia and cardiac fibrOsis in endUrance eXperienced athletes) was higher than previously reported including those studies which also excluded RVIP LGE from the definition of LV fibrosis.10,11”
From Ventricular Arrhythmia and Cardiac Fibrosis in Endurance Experienced Athletes (VENTOUX) (2025) · cites this paper as [11]
Atherosclerotic plaques might not necessarily have the same clinical relevance in athletes and nonathletes, as they are often more calcific in athletes.
“atherosclerotic plaques might not necessarily have the same clinical relevance in athletes and nonathletes, as they are often (but not always 34 ) more calcific--which are considered more stable and less prone to rupture--in the former.35,36”
From Exercise benefits in cardiovascular diseases: From mechanisms to clinical implementation (2023) · cites this paper as [36]
Cites
The Physical Activity Guidelines for Americans
Piercy, K. L., Troiano, R. P., Ballard, R. M., Carlson, S. A., Fulton, J. E., Galuska, D. A., George, S. M., & Olson, R. D. (2018) · JAMA · doi:10.1001/jama.2018.14854 · Cited by 9,755 · see citing works
CORONARY HEART-DISEASE AND PHYSICAL ACTIVITY OF WORK
Morris, J. N., Heady, J. A., Raffle, P. A. B., Roberts, C., & Parks, J. W. (1953) · The Lancet · doi:10.1016/s0140-6736(53)90665-5 · Cited by 1,699 · see citing works
Arem, H., Moore, S. C., Patel, A., Hartge, P., Berrington de Gonzalez, A., Visvanathan, K., Campbell, P. T., Freedman, M., Weiderpass, E., Adami, H. O., et al. (2015) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2015.0533 · Cited by 1,498 · see citing works
Assessment of Coronary Artery Disease by Cardiac Computed Tomography
Budoff, M. J., Achenbach, S. S., Blumenthal, R. S., Carr, J. J., Goldin, J. G., Greenland, P., Guerci, A. D., Lima, J. A. C., Rader, D. J., Rubin, G. D., et al. (2006) · Circulation · doi:10.1161/circulationaha.106.178458 · Cited by 1,391 · see citing works
Estrogen and coronary heart disease in women
Barrett-Connor, E. (1991) · JAMA: The Journal of the American Medical Association · doi:10.1001/jama.1991.03460140089033 · Cited by 1,241 · see citing works
Leipsic, J. A., Abbara, S., Achenbach, S. S., Cury, R. C., Earls, J. P., Mancini, G. J., Nieman, K., Pontone, G., & Raff, G. L. (2014) · Journal of cardiovascular computed tomography · doi:10.1016/j.jcct.2014.07.003 · Cited by 1,086 · see citing works
Exercise Type and Intensity in Relation to Coronary Heart Disease in Men
Tanasescu, M. (2002) · JAMA · doi:10.1001/jama.288.16.1994 · Cited by 928 · see citing works
McClelland, R. L., Chung, H., Detrano, R., Post, W., & Kronmal, R. A. (2006) · Circulation · doi:10.1161/circulationaha.105.580696 · Cited by 885 · see citing works
CORONARY HEART-DISEASE AND PHYSICAL ACTIVITY OF WORK
Morris, J. N., Heady, J. A., Raffle, P. A. B., Roberts, C. G., & Parks, J. W. (1953) · The Lancet · doi:10.1016/s0140-6736(53)91495-0 · Cited by 776 · see citing works
O’Donovan, G., Blazevich, A. J., Boreham, C. A., Cooper, A. R., Crank, H., Ekelund, U., Fox, K. R., Gately, P., Giles‐Corti, B., Gill, J. M. R., et al. (2010) · Journal of Sports Sciences · doi:10.1080/02640411003671212 · Cited by 685 · see citing works
Sex Differences in Coronary Heart Disease
Barrett-Connor, E. L. (1997) · Circulation · doi:10.1161/01.cir.95.1.252 · Cited by 648 · see citing works
Calcium Density of Coronary Artery Plaque and Risk of Incident Cardiovascular Events
Criqui, M. H., Denenberg, J. O., Ix, J. H., McClelland, R. L., Wassel, C. L., Rifkin, D. E., Carr, J. J., Budoff, M. J., & Allison, M. A. (2014) · JAMA · doi:10.1001/jama.2013.282535 · Cited by 642 · see citing works
Mohlenkamp, S., Lehmann, N., Breuckmann, F., Brocker-Preuss, M., Nassenstein, K., Halle, M., Budde, T., Mann, K., Barkhausen, J., Heusch, G., et al. (2008) · European Heart Journal · doi:10.1093/eurheartj/ehn163 · Cited by 487 · see citing works
Potential Adverse Cardiovascular Effects From Excessive Endurance Exercise
O’Keefe, J. H., Patil, H., Lavie, C. J., Magalski, A., Vogel, R. A., & McCullough, P. A. (2012) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2012.04.005 · Cited by 471 · see citing works
Dose of Jogging and Long-Term Mortality
Schnohr, P., O’Keefe, J. H., Marott, J. L., Lange, P., & Jensen, G. B. (2015) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2014.11.023 · Cited by 416 · see citing works
Kojda, G., & Hambrecht, R. (2005) · Cardiovascular Research · doi:10.1016/j.cardiores.2005.04.032 · Cited by 370 · see citing works
Impact of a Competitive Marathon Race on Systemic Cytokine and Neutrophil Responses
Suzuki, K., Nakaji, S., Yamada, M., Liu, Q., Kurakake, S., Okamura, N., Kumae, T., Umeda, T., & Sugawara, K. (2003) · Medicine & Science in Sports & Exercise · doi:10.1249/01.mss.0000048861.57899.04 · Cited by 366 · see citing works
Bourassa, M. G., Butnaru, A., Lespérance, J., et al. (2003) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(02)02768-7 · Cited by 323 · see citing works
Diverse patterns of myocardial fibrosis in lifelong, veteran endurance athletes
Wilson, M., O'Hanlon, R., Prasad, S., Deighan, A., MacMillan, P., Oxborough, D., Godfrey, R., Smith, G., Maceira, A., Sharma, S., et al. (2011) · Journal of Applied Physiology · doi:10.1152/japplphysiol.01280.2010 · Cited by 298 · see citing works
Self-citationBreuckmann, F., Möhlenkamp, S., Naßenstein, K., Lehmann, N., Ladd, S. C., Schmermund, A., Sievers, B., Schlosser, T. W., Jöckel, K., Heusch, G., et al. (2009) · Radiology · doi:10.1148/radiol.2511081118 · Cited by 291 · see citing works
EHRA/HRS/APHRS expert consensus on ventricular arrhythmias
Pedersen, C. T., Kay, G. N., Kalman, J., Borggrefe, M., Della-Bella, P., Dickfeld, T., Dorian, P., Huikuri, H., Kim, Y.-H., Knight, B., et al. (2014) · Heart Rhythm · doi:10.1016/j.hrthm.2014.07.024 · Cited by 288 · see citing works
Armstrong, M. E. G., Green, J., Reeves, G. K., Beral, V., & Cairns, B. J. (2015) · Circulation · doi:10.1161/circulationaha.114.010296 · Cited by 219 · see citing works
Do older athletes reach limits in their performance during marathon running?
Lepers, R., & Cattagni, T. (2011) · AGE · doi:10.1007/s11357-011-9271-z · Cited by 210 · see citing works
The Prevalence and Anatomical Patterns of Intramuscular Coronary Arteries
Konen, E., Goitein, O., Sternik, L., et al. (2007) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2006.09.039 · Cited by 194 · see citing works
Coronary artery size and dilating capacity in ultradistance runners
Haskell, W. L., Sims, C., Myll, J., Bortz, W. M., St Goar, F. G., & Alderman, E. L. (1993) · Circulation · doi:10.1161/01.cir.87.4.1076 · Cited by 193 · see citing works
Sharma, S., Elliot, P. M., Whyte, G., Mahon, N., Virdee, M. S., Mist, B., & McKenna, W. J. (2000) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(00)00816-0 · Cited by 178 · see citing works
Self-citationEffect of marathon running on inflammatory and hemostatic markers
Siegel, A. J., Stec, J. J., Lipinska, I., Cott, E. M. V., Lewandrowski, K. B., Ridker, P. M., & Tofler, G. H. (2001) · The American Journal of Cardiology · doi:10.1016/s0002-9149(01)01909-9 · Cited by 139 · see citing works
Sudden Cardiac Death in the Older Athlete
Chugh, S. S., & Weiss, J. B. (2015) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2014.10.064 · Cited by 139 · see citing works
Ahmadi, N., Nabavi, V., Hajsadeghi, F., et al. (2010) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2010.08.034 · Cited by 105 · see citing works
Sudden Cardiac Arrest and Death in United States Marathons
Webner, D., DuPrey, K., Drezner, J. A., et al. (2012) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0b013e318258b59a · Cited by 95 · see citing works
Pedoe, D. S. T. (2007) · Sports Medicine · doi:10.2165/00007256-200737040-00046 · Cited by 91 · see citing works
Acute Effects of 2 Hours of Moderate-Intensity Cycling on Serum Parathyroid Hormone and Calcium
Barry, D. W., & Kohrt, W. M. (2007) · Calcified Tissue International · doi:10.1007/s00223-007-9028-y · Cited by 82 · see citing works
Increased Coronary Artery Plaque Volume Among Male Marathon Runners.
Schwartz, R. S., Kraus, S. M., Schwartz, J. G., Wickstrom, K., Peichel, G. A., Garberich, R., Lesser, J. R., Oesterle, S. N., Knickelbine, T., Harris, K. M., et al. (2014) · Europe PMC (PubMed Central) · Cited by 82 · see citing works
Braber, T. L., Mosterd, A., Prakken, N. H. J., Rienks, R., Nathoe, H. M., Mali, W. P. T. M., Doevendans, P. A., BACKX, F. J. G., Bots, M. L., Grobbee, D. E., et al. (2016) · European Journal of Preventive Cardiology · doi:10.1177/2047487316651825 · Cited by 74 · see citing works
Marathon related cardiac arrest risk differences in men and women
Roberts, W. O., Roberts, D. M., & Lunos, S. A. (2012) · British Journal of Sports Medicine · doi:10.1136/bjsports-2012-091119 · Cited by 68 · see citing works
BRADYCARDIA, VENTRICULAR PAUSES, SYNCOPE, AND SPORTS
Ector, H., Verlinden, M. H., Eynde, E. V., Bourgois, J., Hermans, L., Fagard, R. H., & Geest, H. D. (1984) · The Lancet · doi:10.1016/s0140-6736(84)90593-2 · Cited by 66 · see citing works
No Evidence of an Upper Threshold for Mortality Benefit at High Levels of Cardiorespiratory Fitness
Feldman, D. I., Al-Mallah, M. H., Keteyian, S. J., et al. (2015) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2014.11.030 · Cited by 63 · see citing works
Long-Term Marathon Running Is Associated with Low Coronary Plaque Formation in Women
Roberts, W. O., Schwartz, R. S., Kraus, S. M., SCHWARTZ, J. G., Peichel, G. A., Garberich, R., Lesser, J. R., Oesterle, S. N., Wickstrom, K., Knickelbine, T., et al. (2016) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000001154 · Cited by 50 · see citing works
Optimal Dose of Running for Longevity
Lee, D.-C., Lavie, C. J., & Vedanthan, R. (2015) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2014.11.022 · Cited by 42 · see citing works
Coronary artery calcium, exercise tolerance, and CHD events in asymptomatic men
LaMonte, M. J., FitzGerald, S. J., Levine, B. D., Church, T. S., Kampert, J. B., Nichaman, M. Z., Gibbons, L. W., & Blair, S. N. (2006) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2005.12.014 · Cited by 39 · see citing works
Acute versus habitual exercise, thrombogenesis and exercise intensity
Lee, K., & Lip, G. Y. H. (2004) · Thrombosis and Haemostasis · doi:10.1055/s-0037-1614284 · Cited by 38 · see citing works
Macrophage-tumour cell associations in breast cancer
van Netten, J., George, E., Ashmead, B. J., et al. (1993) · The Lancet · doi:10.1016/0140-6736(93)92734-b · Cited by 29 · see citing works
Sudden Death in Marathon Runners
James, J., Merghani, A., & Sharma, S. (2013) · Cardiac Electrophysiology Clinics · doi:10.1016/j.ccep.2013.01.003 · Cited by 9 · see citing works
Self-citationOestrogen and protection against myocardial ischaemia
Versi, E., Collins, P. D., Stevenson, J., Godsland, I. F., Riedel, M., & Mügge, A. (1993) · The Lancet · doi:10.1016/0140-6736(93)92733-a · Cited by 9 · see citing works
Flagged first, then by citations
Research works printed but not linked: 1
- Oxborough D, Zaidi A, Gati S, Papadakis M, Sheikh N, Sharma S. A guideline for the practice of echocardiography in the cardiovascular screening of sports participants: a joint policy statement of the British Society of Echocardiography and Cardiac Risk in the Young. ECHO – J Br Soc Echocardiogr. 2013;1:1–8.
Cited by
Sorted by citations
Arnett, D. K., Blumenthal, R. S., Albert, M. A., Buroker, A. B., Goldberger, Z. D., Hahn, E. J., Himmelfarb, C. D., Khera, A., Lloyd-Jones, D., McEvoy, J. W., et al. (2019) · Circulation · doi:10.1161/cir.0000000000000678 · Cited by 4,536 · see citing works
2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease
Arnett, D. K., Blumenthal, R. S., Albert, M. A., Buroker, A. B., Goldberger, Z. D., Hahn, E. J., Himmelfarb, C. D., Khera, A., Lloyd-Jones, D., McEvoy, J. W., et al. (2019) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2019.03.010 · Cited by 1,896 · see citing works
Borén, J., Chapman, M. J., Krauss, R. M., Packard, C. J., Bentzon, J. F., Binder, C. J., Daemen, M. J., Demer, L. L., Hegele, R. A., Nicholls, S. J., et al. (2020) · European Heart Journal · doi:10.1093/eurheartj/ehz962 · Cited by 1,601 · see citing works
Physical activity, all-cause and cardiovascular mortality, and cardiovascular disease
KRAUS, W. E., POWELL, K. E., HASKELL, W. L., JANZ, K. F., CAMPBELL, W. W., JAKICIC, J. M., TROIANO, R. P., SPROW, K., TORRES, A., & PIERCY, K. L. (2019) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000001939 · Cited by 671 · see citing works
Franklin, B. A., Thompson, P. D., Al-Zaiti, S. S., Albert, C. M., Hivert, M.-F., Levine, B. D., Lobelo, F., Madan, K., Sharrief, A. Z., Eijsvogels, T. M. H., et al. (2020) · Circulation · doi:10.1161/cir.0000000000000749 · Cited by 410 · see citing works
Exercise benefits in cardiovascular diseases: From mechanisms to clinical implementation
Valenzuela, P. L., Ruilope, L. M., Santos-Lozano, A., Wilhelm, M., Kränkel, N., Fiuza-Luces, C., & Lucia, A. (2023) · European Heart Journal · doi:10.1093/eurheartj/ehad170 · Cited by 237 · see citing works
Aengevaeren, V. L., Mosterd, A., Sharma, S., Prakken, N. H. J., Möhlenkamp, S., Thompson, P. D., Velthuis, B. K., & Eijsvogels, T. M. H. (2020) · Circulation · doi:10.1161/circulationaha.119.044467 · Cited by 165 · see citing works
Self-citationLifelong endurance exercise and its relation with coronary atherosclerosis
De Bosscher, R., Dausin, C., Claus, P., Bogaert, J., Dymarkowski, S., Goetschalckx, K., Ghekiere, O., Van De Heyning, C. M., Van Herck, P., Paelinck, B., et al. (2023) · European Heart Journal · doi:10.1093/eurheartj/ehad152 · Cited by 140 · see citing works
“In 2017, two other studies added a relevant nuance that athletes presenting with coronary plaques were more likely to have calcified plaques, whereas non-athletes with plaques more frequently had mixed plaques.(3,4) Since calcified plaques are more stable and less prone to rupture than mixed and non-calcified plaques,…”
BackgroundMethodResultInfluentialLong-Term All-Cause and Cause-Specific Mortality in Asymptomatic Patients With CAC ≥1,000
Peng, A. W., Mirbolouk, M., Orimoloye, O. A., Osei, A. D., Dardari, Z., Dzaye, O., Budoff, M. J., Shaw, L., Miedema, M. D., Rumberger, J., et al. (2020) · JACC: Cardiovascular Imaging · doi:10.1016/j.jcmg.2019.02.005 · Cited by 134 · see citing works
Aengevaeren, V. L., Mosterd, A., Bakker, E. A., Braber, T. L., Nathoe, H. M., Sharma, S., Thompson, P. D., Velthuis, B. K., & Eijsvogels, T. M. H. (2023) · Circulation · doi:10.1161/circulationaha.122.061173 · Cited by 115 · see citing works
Self-citationThe effects of endurance exercise on the heart: panacea or poison?
Parry-Williams, G., & Sharma, S. (2020) · Nature Reviews Cardiology · doi:10.1038/s41569-020-0354-3 · Cited by 102 · see citing works
Self-citationSvedberg, N., Sundström, J., James, S., Hållmarker, U., Hambraeus, K., & Andersen, K. (2019) · Circulation · doi:10.1161/circulationaha.118.039461 · Cited by 92 · see citing works
Coronary atherosclerosis in athletes: emerging concepts and preventive strategies
Claessen, G., Eijsvogels, T. M. H., Albert, C. M., Baggish, A. L., Levine, B. D., Marijon, E., Michos, E. D., & La Gerche, A. (2025) · European Heart Journal · doi:10.1093/eurheartj/ehae927 · Cited by 43 · see citing works
GERMAN, C. A., FANNING, J., SINGLETON, M. J., SHAPIRO, M. D., BRUBAKER, P. H., BERTONI, A. G., & YEBOAH, J. (2022) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000002856 · Cited by 23 · see citing works
Ventricular Arrhythmia and Cardiac Fibrosis in Endurance Experienced Athletes (VENTOUX)
Javed, W., Botis, I., Goh, Z. M., Shabi, M., Brown, B., Tomoaia, R., Farooq, M., Levelt, E., Graham, L., Gierula, J., et al. (2025) · Circulation: Cardiovascular Imaging · doi:10.1161/circimaging.125.018470 · Cited by 21 · see citing works
“10,11 This may be explained by our study only including older male athletes (age was the variable most significantly associated with myocardial fibrosis).”
MACEIRA, A., VALENZUELA, P. L., SANTOS-LOZANO, A., GARCÍA-GONZÁLEZ, M. P., ORTEGA, L. H., DÍAZ-GONZALEZ, L., BORAITA, A., BARRANCO-GIL, D., & LUCIA, A. (2023) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000003043 · Cited by 9 · see citing works
Pauwels, R., Dausin, C., Ruiz-Carmona, S., De Bosscher, R., De Paepe, J., Bekhuis, Y., Delpire, B., Sinnaeve, P., Dymarkowski, S., Ghekiere, O., et al. (2026) · Circulation · doi:10.1161/circulationaha.125.077117 · Cited by 3 · see citing works
De Paepe, J., D’Ambrosio, P., De Bosscher, R., Bekhuis, Y., Pauwels, R., Dausin, C., Janssens, K., Mitchell, A., Elliott, A., Van De Heyning, C. M., et al. (2026) · European Journal of Preventive Cardiology · doi:10.1093/eurjpc/zwaf715 · Cited by 2 · see citing works
O’Driscoll, J., Parry-Williams, G., Moser, J., Vlahos, I., Obaid, D., Basu, J., Finocchiaro, G., Fyyaz, S., MacLachlan, H., Marwaha, S., et al. (2026) · British Journal of Sports Medicine · doi:10.1136/bjsports-2025-111347
Self-citation
- Authors
- Merghani, A., Maestrini, V., Rosmini, S., Cox, A. T., Dhutia, H., Bastiaenan, R., David, S., Yeo, T. J., Narain, R., Malhotra, A., Papadakis, M., Wilson, M. G., Tome, M., AlFakih, K., Moon, J. C., & Sharma, S.
- Affiliations
- St George's, University of London (GB)
- ORCID
- Venue
- Circulation
- Published
- 2017-07-11
- Volume
- 136
- Issue
- 2
- Pages
- 126-137
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2611722420
- Semantic Scholar
- 87a28864e91509f230f507f6a995685547e28580
- Cited by
- 398
- References
- 45
- Citations by year
- 2026: 26 · 2025: 43 · 2024: 42 · 2023: 43 · 2022: 52 · 2021: 56 · 2020: 47 · 2019: 41 · 2018: 36 · 2017: 11
- FWCI
- 24.57
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- St George's Online Research Archive (St George's University of London) (acceptedVersion)
- UCL Discovery (University College London) (submittedVersion)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
- Research Explorer (The University of Manchester) (submittedVersion, other-oa)
- Funders
- National Institute for Health and Care Research (CL-2017-16-001, CL-2014-16-002, CL-2011-16-501)
- British Heart Foundation (FS/14/16/30671)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Effects of Exercise
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Keywords
- subclinical coronary artery disease, masters athletes, endurance athletes, coronary artery calcium, atherosclerotic plaque morphology, luminal stenosis, late gadolinium enhancement, myocardial infarction, training duration, sex differences, cardiovascular magnetic resonance imaging, coronary CT angiography, exercise stress testing, marathon runners, sedentary controls
- MeSH terms
- Adult, Aged, Aged, 80 and over, Bicycling, Coronary Artery Disease, Exercise Test, Female, Humans, Male, Middle Aged, Physical Endurance, Risk Factors, Running, Cohort Studies, Prevalence, Athletes, Plaque, Atherosclerotic
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
