Exercise Volume Versus Intensity and the Progression of Coronary Atherosclerosis in Middle-Aged and Older Athletes: Findings From the MARC-2 Study
Open accessAbstract
Background: Physical activity and exercise training are associated with a lower risk for coronary events. However, cross-sectional studies in middle-aged and older male athletes revealed increased coronary artery calcification (CAC) and atherosclerotic plaques, which were related to the amount and intensity of lifelong exercise. We examined the longitudinal relationship between exercise training characteristics and coronary atherosclerosis. Methods: Middle-aged and older men from the MARC-1 (Measuring Athlete’s Risk of Cardiovascular Events 1) study were invited for follow-up in MARC-2 (Measuring Athlete’s Risk of Cardiovascular Events 2) study. The prevalence and severity of CAC and plaques were determined by coronary computed tomography angiography. The volume (metabolic equivalent of task [MET] hours/week) and intensity (moderate [3 to 6 MET hours/week]; vigorous [6 to 9 MET hours/week]; and very vigorous [≥9 MET hours/week]) of exercise training were quantified during follow-up. Linear and logistic regression analyses were performed to determine the association between exercise volume/intensity and markers of coronary atherosclerosis. Results: We included 289 (age, 54 [50 to 60] years [median (Q1 to Q3)]) of the original 318 MARC-1 participants with a follow-up of 6.3±0.5 years (mean±SD). Participants exercised for 41 (25 to 57) MET hours/week during follow-up, of which 0% (0 to 19%) was at moderate intensity, 44% (0 to 84%) was at vigorous intensity, and 34% (0 to 80%) was at very vigorous intensity. Prevalence of CAC and the median CAC score increased from 52% to 71% and 1 (0 to 32) to 31 (0 to 132), respectively. Exercise volume during follow-up was not associated with changes in CAC or plaque. Vigorous intensity exercise (per 10% increase) was associated with a lesser increase in CAC score (β, −0.05 [−0.09 to −0.01]; P =0.02), whereas very vigorous intensity exercise was associated with a greater increase in CAC score (β, 0.05 [0.01 to 0.09] per 10%; P =0.01). Very vigorous exercise was also associated with increased odds of dichotomized plaque progression (adjusted odds ratio [aOR], 1.09 [1.01 to 1.18] per 10%; aOR, 2.04 [0.93 to 4.15] for highest versus lowest very vigorous intensity tertiles, respectively), and specifically with increased calcified plaques (aOR, 1.07 [1.00 to 1.15] per 10%; aOR, 2.09 [1.09 to 4.00] for highest versus lowest tertile, respectively). Conclusions: Exercise intensity but not volume was associated with progression of coronary atherosclerosis during 6-year follow-up. It is intriguing that very vigorous intensity exercise was associated with greater CAC and calcified plaque progression, whereas vigorous intensity exercise was associated with less CAC progression.
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Previous studies examining the link between training characteristics and CAD have yielded conflicting results, probably resulting from differences in training load definitions and measurement approaches.
“Previous studies examining the link between training characteristics and CAD have yielded conflicting results, probably resulting from differences in TL definitions and measurement approaches.12–14”
From Wearable-Derived Training Load and Coronary Atherosclerosis in Middle-Aged and Older Athletes and Physically Active Controls: A New Perspective From the Master@Heart Study (2026) · cites this paper as [14]
The Exercise Volume section (page unavailable) describes differing findings across studies: MARC-2 found no association with progression, while a Korean population study found greater CAC progression in a more active group. It also describes different activity categories and suggests that follow-up duration may matter, but it does not say that differences in training-load definitions and measurement approaches probably caused the conflicting results. (LLM, conf=0.82)
Experimental — accuracy not yet measuredAengevaeren et al defined "very vigorous" exercise intensity as >9 METs, a threshold commonly exceeded by endurance athletes and insufficient to distinguish training extremes in this population.
“However, they defined “very vigorous” exercise intensity as >9 METs, a threshold commonly exceeded by endurance athletes and insufficient to distinguish training extremes in this population.14,17”
From Wearable-Derived Training Load and Coronary Atherosclerosis in Middle-Aged and Older Athletes and Physically Active Controls: A New Perspective From the Master@Heart Study (2026) · cites this paper as [14]
The methods passage (page unavailable) defines very vigorous exercise as ≥9 METs, not strictly >9 METs. The Results report a median of 34% of exercise volume at that intensity among participants, but the paper does not say the threshold is commonly exceeded by endurance athletes generally or that it is insufficient to distinguish training extremes. (LLM, conf=0.87)
Experimental — accuracy not yet measuredAengevaeren et al later reported a relationship between high-intensity exercise, rather than exercise volume, with CAD progression.
“and later reported a relationship between high-intensity exercise, rather than exercise volume, with CAD progression.14”
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Cites
Quantification of coronary artery calcium using ultrafast computed tomography
Agatston, A. S., Janowitz, W. R., Hildner, F. J., Zusmer, N. R., Viamonte, M., & Detrano, R. (1990) · Journal of the American College of Cardiology · doi:10.1016/0735-1097(90)90282-t · Cited by 7,786 · 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 · cited 1× · see citing works
“CAC score >100, n (%) 43 (15) 89 (31) <0.”
Sangiorgi, G., Rumberger, J., Severson, A. R., Edwards, W., Grégoire, J., Fitzpatrick, L., & Schwartz, R. S. (1998) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(97)00443-9 · Cited by 1,075 · 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
2011 Compendium of Physical Activities: A Second Update of Codes and MET Values
Shephard, R. (2012) · Yearbook of Sports Medicine · doi:10.1016/j.yspm.2011.08.057 · Cited by 605 · cited 1× · see citing works
“CAC score >400, n (%) 18 (6) 38 (13) <0.”
Shiroma, E. J., & Lee, I.-M. (2010) · Circulation · doi:10.1161/circulationaha.109.914721 · Cited by 578 · see citing works
Impact of Statins on Serial Coronary Calcification During Atheroma Progression and Regression
Puri, R., Nicholls, S. J., Shao, M., Kataoka, Y., Uno, K., Kapadia, S. R., Tuzcu, E. M., & Nissen, S. E. (2015) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2015.01.036 · Cited by 571 · 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
Progression of coronary artery calcium predicts all-cause mortality.
Budoff, M., Hokanson, J., Nasir, K., Shaw, L., Kinney, G., Chow, D., Demoss, D., Nuguri, V., Nabavi, V., Ratakonda, R., et al. (2010) · JACC Cardiovascular Imaging · doi:10.1016/j.jcmg.2010.08.018 · Cited by 477 · see citing works
Rozanski, A., Gransar, H., Shaw, L., Kim, J., Miranda-Peats, L., Wong, N., Rana, J., Orakzai, R., Hayes, S., Friedman, J., et al. (2011) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2011.01.019 · Cited by 462 · see citing works
Retarding effect of lowered heart rate on coronary atherosclerosis.
Beere, P., Glagov, S., & Zarins, C. K. (1984) · Science · doi:10.1126/science.6484569 · Cited by 403 · see citing works
Merghani, A., Maestrini, V., Rosmini, S., Cox, A. T., Dhutia, H., Bastiaenan, R., David, S., Yeo, T. J., Narain, R., Malhotra, A., et al. (2017) · Circulation · doi:10.1161/circulationaha.116.026964 · Cited by 398 · see citing works
Self-citationHou, Z.-H., Lu, B., Gao, Y., Jiang, S.-L., Wang, Y., Li, W., & Budoff, M. J. (2012) · JACC: Cardiovascular Imaging · doi:10.1016/j.jcmg.2012.06.006 · Cited by 321 · see citing works
Relationship between lifelong exercise volume and coronary atherosclerosis in athletes.
Aengevaeren, V. L., Mosterd, A., Braber, T. L., Prakken, N. H. J., Doevendans, P. A., Grobbee, D. E., Thompson, P. D., Eijsvogels, T. M. H., & Velthuis, B. K. (2017) · Circulation · doi:10.1161/circulationaha.117.027834 · Cited by 309 · cited 2× · see citing works
“CAC score >400, n (%) 18 (6) 38 (13) <0.”
Self-citationCoronary Artery Calcium Scanning
Hecht, H. S. (2015) · JACC. Cardiovascular imaging · doi:10.1016/j.jcmg.2015.02.006 · Cited by 306 · see citing works
Exercise at the Extremes: The Amount of Exercise to Reduce Cardiovascular Events.
Eijsvogels, T., Molossi, S., Lee, D.-C., Emery, M., & Thompson, P. (2016) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2015.11.034 · Cited by 297 · cited 1× · see citing works
“CAC score >1000, n (%) 4 (1) 17 (6) <0.”
Self-citationThe lifetime total physical activity questionnaire: development and reliability.
Friedenreich, C. M., Courneya, K., & Bryant, H. E. (1998) · Medicine & Science in Sports & Exercise · doi:10.1097/00005768-199802000-00015 · Cited by 295 · see citing works
Silverman, M., Blaha, M., Krumholz, H., Budoff, M., Blankstein, R., Sibley, C., Agatston, A., Blumenthal, R., & Nasir, K. (2014) · European Heart Journal · doi:10.1093/eurheartj/eht508 · Cited by 294 · see citing works
Mcevoy, J., Blaha, M., DeFilippis, A., Budoff, M., Nasir, K., Blumenthal, R., & Jones, S. (2010) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2010.06.038 · Cited by 273 · see citing works
DeFina, L. F., Radford, N. B., Barlow, C. E., Willis, B. L., Leonard, D., Haskell, W. L., Farrell, S. W., Pavlovic, A., Abel, K., Berry, J. D., et al. (2019) · JAMA Cardiology · doi:10.1001/jamacardio.2018.4628 · Cited by 213 · see citing works
Association of Statin Treatment With Progression of Coronary Atherosclerotic Plaque Composition.
van Rosendael, A. V., van den Hoogen, I. J., Gianni, U., Ma, X.-Y., Tantawy, S., Bax, A., Lu, Y., Andreini, D., Al-Mallah, M., Budoff, M., et al. (2021) · JAMA cardiology · doi:10.1001/jamacardio.2021.3055 · Cited by 175 · cited 1× · see citing works
“Presence of noncalcified plaques 60 (33) 124 (52)”
BackgroundElite athletes live longer than the general population: a meta-analysis.
Garatachea, N., Santos-Lozano, A., Sanchis-Gomar, F., Fiuza-Luces, C., Pareja-Galeano, H., Emanuele, E., & Lucia, A. (2014) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2014.06.004 · Cited by 173 · cited 1× · see citing works
“CAC score >100, n (%) 43 (15) 89 (31) <0.”
Bamberg, F., Sommer, W. H., Hoffmann, V., Achenbach, S., Nikolaou, K., Conen, D., Reiser, M. F., Hoffmann, U., & Becker, C. R. (2011) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2010.12.043 · Cited by 173 · see citing works
Myocardial fibrosis in athletes.
van de Schoor, F. R., Aengevaeren, V. L., Hopman, M. T. E., Oxborough, D. L., George, K. P., Thompson, P. D., & Eijsvogels, T. M. H. (2016) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2016.07.012 · Cited by 168 · see citing works
Self-citationCatecholamines Induce Trained Immunity in Monocytes In Vitro and In Vivo
van der Heijden, C. D. C. C., Groh, L. A., Keating, S. T., Kaffa, C., Noz, M. P., Kersten, S., van Herwaarden, A. E., Hoischen, A., Joosten, L. A. B., Timmers, H. J. L. M., et al. (2020) · Circulation Research · doi:10.1161/circresaha.119.315800 · Cited by 167 · cited 1× · see citing works
“≥75th MESA percentile, n (%) 65 (22) 74 (26) 0.”
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-citationExercise-related out-of-hospital cardiac arrest in the general population: incidence and prognosis
Berdowski, J., de Beus, M. F., Blom, M., Bardai, A., Bots, M. L., Doevendans, P. A., Grobbee, D. E., Tan, H. L., Tijssen, J. G. P., Koster, R. W., et al. (2013) · European Heart Journal · doi:10.1093/eurheartj/eht401 · Cited by 148 · see citing works
Self-citationRadford, N. B., DeFina, L. F., Leonard, D., Barlow, C. E., Willis, B. L., Gibbons, L. W., Gilchrist, S. C., Khera, A., & Levine, B. D. (2018) · Circulation · doi:10.1161/circulationaha.117.032708 · Cited by 120 · see citing works
Erbel, R., Lehmann, N., Churzidse, S., Rauwolf, M., Mahabadi, A., Möhlenkamp, S., Moebus, S., Bauer, M., Kälsch, H., Budde, T., et al. (2014) · European Heart Journal · doi:10.1093/eurheartj/ehu288 · Cited by 100 · cited 1× · see citing works
“≥75th MESA percentile, n (%) 65 (22) 74 (26) 0.”
Physical activity and the progression of coronary artery calcification
Sung, K., Hong, Y., Lee, J., Lee, S.-J., Chang, Y., Ryu, S., Zhao, D., Cho, J., Guallar, E., & Lima, J. (2021) · Heart · doi:10.1136/heartjnl-2021-319346 · Cited by 52 · see citing works
Mortality and health-related habits in 900 Finnish former elite athletes and their brothers
Kontro, T. K., Sarna, S. J., Kaprio, J. A., & Kujala, U. M. (2017) · British Journal of Sports Medicine · doi:10.1136/bjsports-2017-098206 · Cited by 35 · see citing works
Catecholamine response to exercise in patients with non‐obstructive hypertrophic cardiomyopathy
Shah, A. B., Bechis, M. Z., Brown, M. G., Finch, J. A. M., Loomer, G., Groezinger, E. Y., Weiner, R., Wasfy, M., Picard, M., Fifer, M., et al. (2019) · Journal of Physiology · doi:10.1113/jp277494 · Cited by 25 · see citing works
Coronary Atherosclerosis in Athletes
Aengevaeren, V. L., Mosterd, A., Sharma, S., Braber, T. L., Thompson, P. D., Velthuis, B. K., & Eijsvogels, T. M. H. (2019) · JACC: Cardiovascular Imaging · doi:10.1016/j.jcmg.2019.01.002 · Cited by 17 · see citing works
Self-citationKleiven, O., Bjørkavoll-Bergseth, M., Omland, T., Aakre, K., Frøysa, V., Erevik, C., Greve, O., Melberg, T., Auestad, B., Skadberg, Ø., et al. (2020) · Scandinavian Journal of Medicine & Science in Sports · doi:10.1111/sms.13643 · Cited by 14 · see citing works
Flagged first, then by citations
1 of the 37 references couldn’t be matched to a known paper.
Research works printed but not linked: 3
- Braber TL, Mosterd A, Prakken NH, Doevendans PA, Mali WP, Backx FJ, Grobbee DE, Rienks R, Nathoe HM, Bots ML, et al. Rationale and design of the Measuring Athlete's Risk of Cardiovascular events (MARC) study: the role of coronary CT in the cardiovascular evaluation of middle-aged sports- men. Neth Heart J. 2015;23:133-138. doi: 10.1007/s12471-014-0630-0 · DOI
- Budoff MJ, Achenbach S, Blumenthal RS, Carr JJ, Goldin JG, Greenland P, Guerci AD, Lima JA, Rader DJ, Rubin GD, et al; American Heart Association Committee on Cardiovascular Imaging and Intervention. Assessment of cor- onary artery disease by cardiac computed tomography: a scientific statement from the American Heart Association Committee on Cardiovascular Imaging and Intervention, Council on Cardiovascular Radiology and Intervention, and Committee on Cardiac Imaging, Council on Clinical Cardiology. Circulation. 2006;114:1761-1791. doi: 10.1161/CIRCULATIONAHA.106.178458 · DOI
- Peng AW, Dardari ZA, Blumenthal RS, Dzaye O, Obisesan OH, Iftekhar Uddin SM, Nasir K, Blankstein R, Budoff MJ, Bodtker Mortensen M, et al. Very high coro- nary artery calcium (≥1000) and association with cardiovascular disease events, non-cardiovascular disease outcomes, and mortality: results from MESA. Circu- lation. 2021;143:1571-1583. doi: 10.1161/CIRCULATIONAHA.120.050545 · DOI
Cited by
Sorted by citations
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
Kim, J. H., Baggish, A. L., Levine, B. D., Ackerman, M. J., Day, S. M., Dineen, E. H., Guseh, J. S., Gerche, A. L., Lampert, R. J., Martinez, M. W., et al. (2025) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2024.12.025 · Cited by 147 · see citing works
Self-citationAtherosclerosis: A Comprehensive Review of Molecular Factors and Mechanisms
Tasouli-Drakou, V., Ogurek, I., Shaikh, T., Ringor, M., Dicaro, M. V., & Lei, K. (2025) · International Journal of Molecular Sciences · doi:10.3390/ijms26031364 · Cited by 79 · see citing works
Exercise Alleviates Cardiovascular Diseases by Improving Mitochondrial Homeostasis
Zhang, H., Zhang, Y., Zhang, J., & Jia, D. (2024) · Journal of the American Heart Association · doi:10.1161/jaha.124.036555 · Cited by 64 · see citing works
“76 High-intensity interval training and moderate-intensity continuous training alike stimulate irisin secretion in skeletal muscles to boost circulating irisin level.”
Exercise mitigates age-related metabolic diseases by improving mitochondrial dysfunction
Jia, D., Tian, Z., & Wang, R. (2023) · Ageing Research Reviews · doi:10.1016/j.arr.2023.102087 · Cited by 47 · 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
“22 7, 11 The comparatively few studies coronary morphology in strength-trained strength-trained athletes have reported mixed findings findings.”
Self-citationCardiac Arrest During Long-Distance Running Races.
Kim, J. H., Rim, A., Miller, J., Jackson, M., Patel, N., Rajesh, S., Ko, Y.-A., DiGregorio, H., Chiampas, G., McGillivray, D., et al. (2025) · Journal of the American Medical Association (JAMA) · doi:10.1001/jama.2025.3026 · Cited by 38 · see citing works
A contemporary review of sudden cardiac arrest and death in competitive and recreational athletes
Kim, J. H., Martinez, M. W., Guseh, J. S., Krishnan, S., Gray, B. R., Harmon, K. G., Papadakis, M., Phelan, D. M. J., Stewart, K., Levine, B. D., et al. (2024) · The Lancet · doi:10.1016/s0140-6736(24)02086-5 · Cited by 41 · see citing works
Geng, J., Zhang, X., Guo, Y., He, W., Guo, D., Liang, Q., Pu, S., Wang, Y., Liu, M., Li, Z., et al. (2025) · Nature Communications · doi:10.1038/s41467-025-55917-8 · Cited by 28 · see citing works
“In addition, vigorous intensity exercise was reported to be associated with an increased progression of coronary artery calci fi cation and atherosclerotic plaques 16 .”
Exercise and the Heart: Benefits, Risks and Adverse Effects of Exercise Training
Mannakkara, N., & Finocchiaro, G. (2023) · Reviews in cardiovascular medicine · doi:10.31083/j.rcm2403094 · Cited by 24 · see citing works
“…been found to have higher CAC scores and amounts of atherosclerosis on CT coronary angiography (CTCA) compared to matched non-athletic controls [151] and very vigorous exercise intensity has been associated with greater CAC and calcified plaque progression in middle-aged and older athletes [152].”
ResultAli, N. B., Esfahani, S. A., Scalia, I., Farina, J., Pereyra, M., Barry, T., Lester, S., Alsidawi, S., Steidley, D., Ayoub, C., et al. (2024) · Journal of Imaging · doi:10.3390/jimaging10090230 · Cited by 22 · see citing works
“Studies, including the MARC-2 study, have found that athletes have higher rates of CAC compared to non-athletes [94].”
BackgroundResultCeleski, M., Gioia, G. D., Nusca, A., Segreti, A., Squeo, M. R., Lemme, E., Mango, F., Ferrera, A., Ussia, G. P., & Grigioni, F. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13175144 · Cited by 21 · see citing works
“This is because endurance athletes may have larger coronary arteries and higher vasodilatory capability [41,113–115].”
BackgroundScarfò, G., Daniele, S., Chelucci, E., Rizza, A., Fusi, J., Freggia, G., Costa, B., Taliani, S., Artini, P., Martini, C., et al. (2023) · Scientific Reports · doi:10.1038/s41598-023-44928-4 · Cited by 18 · see citing works
“In considering our results, it should be mentioned that emerging evidence supports that regular strenuous exercise increases coronary artery disease risk 44 and oxidative stress in the tunic media 45,46 .”
ResultAtrial fibrillation in former world-class rowers: role of environmental and genetic factors
Flannery, D., Cánovas, R., Janssens, K., Mitchell, A. M., D’Ambrosio, P., Spencer, L. W., Rowe, S. J., Paratz, E. D., Claessen, G., Myrstad, M., et al. (2025) · European Heart Journal · doi:10.1093/eurheartj/ehaf369 · Cited by 26 · see citing works
“33,34 The population was dichoto-mized into those athletes who continued to exercise vigorously after their rowing career (termed ‘Lifelong Athletes’) and were defined as those who engaged in ≥ 5 cumulative hours per week of high-intensity exercise in the 5 years preceding enrolment and had a…”
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Zhang, Z., Yang, Z., Wang, S., Wang, X., & Mao, J. (2024) · Biomedicine & Pharmacotherapy · doi:10.1016/j.biopha.2024.116761 · Cited by 18 · see citing works
Physical Activity and Progression of Coronary Artery Calcification in Men and Women
Shuval, K., Leonard, D. S., DeFina, L. F., Barlow, C. E., Berry, J. D., Turlington, W. M., Pavlovic, A., Radford, N. B., Gabriel, K. P., Khera, A., et al. (2024) · JAMA Cardiology · doi:10.1001/jamacardio.2024.0759 · Cited by 19 · see citing works
Potential mechanisms linking high-volume exercise with coronary artery calcification
Zambrano, A., Tintut, Y., Demer, L. L., & Hsu, J. J. (2023) · Heart · doi:10.1136/heartjnl-2022-321986 · Cited by 19 · see citing works
Extreme endurance training and coronary artery disease: A systematic review and a meta-analysis.
Guarnieri, G., Pozzi, F. E., Conte, E., Righetto, M., Bartorelli, A., & Andreini, D. (2025) · International Journal of Cardiology · doi:10.1016/j.ijcard.2025.133172 · Cited by 13 · see citing works
Kumar, P., Roy, S., & Das, P. K. (2024) · Physics of Fluids · doi:10.1063/5.0185437 · Cited by 13 · see citing works
Liu, Y., Yang, Y., Wu, H., Yang, H., Chen, L., Sun, F., & Xia, Y. (2024) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2024.104786 · Cited by 13 · see citing works
From Cells to Plaques: The Molecular Pathways of Coronary Artery Calcification and Disease
Mitsis, A., Khattab, E., Christodoulou, E., Myrianthopoulos, K., Myrianthefs, M. M., Tzikas, S., Ziakas, A., Fragakis, N., & Kassimis, G. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13216352 · Cited by 11 · see citing works
“Recently, the MARC-2 study suggests that exercise intensity but not volume is associated with coronary artery calcification progression [108].”
BackgroundArrhythmias and structural remodeling in lifelong and retired master endurance athletes
D’Ambrosio, P., Paepe, J. D., Janssens, K., Mitchell, A. M., Rowe, S. J., Spencer, L. W., Puyvelde, T. V., Bogaert, J., Ghekiere, O., Pauwels, R. W. J., et al. (2025) · Journal of sport and health science/Journal of Sport and Health Science · doi:10.1016/j.jshs.2025.101043 · Cited by 12 · see citing works
“19,20”
Connecting the Dots: How Injury in the Arterial Wall Contributes to Atherosclerotic Disease.
Belhoul-Fakir, H., Brown, M. L., Thompson, P. L., Hamzah, J., & Jansen, S. (2023) · Clinical Therapeutics · doi:10.1016/j.clinthera.2023.10.004 · Cited by 10 · see citing works
Self-citationExercise-mediated epigenetic modifications in cardiovascular diseases.
Yang, X.-Y., Zhang, Y., Wang, X., Chen, S., Zheng, Y., Hou, X., Wang, S., Zheng, X., Li, Q.-F., Sun, Y., et al. (2024) · Epigenomics · doi:10.1080/17501911.2024.2447811 · Cited by 8 · see citing works
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Eijsvogels, T. M. H., Kim, J. H., Aengevaeren, V. L., D’Ascenzi, F., Churchill, T., Dineen, E. H., la Garza, M. S., Gati, S., Hálasz, G., Haugaa, K. H., et al. (2026) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2026.03.025 · Cited by 6 · see citing works
Self-citationLiu, H., Wang, Z.-L., Zhou, S., Lin, Y., Ma, G., Zhang, R., & Yu, P. (2025) · Journal of Science and Medicine in Sport · doi:10.1016/j.jsams.2025.08.020 · Cited by 7 · see citing works
RetractedPhysical Activity, Cardiorespiratory Fitness and Atherosclerotic Cardiovascular Disease: Part 1
Franklin, B. A., & Jae, S. Y. (2024) · Pulse · doi:10.1159/000541165 · Cited by 11 · see citing works
“Aengevaeren et al. [48] demonstrated mixed re-sults, showing that vigorous-intensity exercise was associated with less CAC progression, whereas very-vigorous-intensity exercise was linked to an increase in both CAC and calci fi ed plaque progression.”
Ahmadi, M., Sabag, A., Biswas, R., Cruz, B. D. P., Chow, C., O’Sullivan, J., Eijsvogels, T., & Stamatakis, E. (2026) · British Journal of Sports Medicine · doi:10.1136/bjsports-2025-109894 · Cited by 6 · see citing works
“51 52 56 Further, there can be possible contraindications of engaging in repeated sustained vigorous intensity activity, such as increased risk of induced cardiac ischaemia and arrhythmias.”
Self-citationCoronary artery calcium and sudden cardiac death: current evidence and future directions
Razavi, A., Whelton, S., Blumenthal, R., Sperling, L., Blaha, M., & Dzaye, O. (2023) · Current Opinion in Cardiology · doi:10.1097/hco.0000000000001081 · Cited by 6 · see citing works
“Among middle-aged men, very vigorous exercise [ 9 metabolic equivalent of task (MET) hours/week] conferred 7% higher odds for the development of calcified plaque on coronary CT angiography [26].”
Zuo, L., Kavousi, M., van Oortmerssen, J. V., Voortman, T., Ikram, M., & Bos, D. (2025) · EBioMedicine · doi:10.1016/j.ebiom.2025.105894 · Cited by 5 · see citing works
“23 In this study, we found no association of moderate level physical activity with IPH or LRNC, supporting the hypothesis that an excessive volume of vigorous level activity, rather than moderate level, may adversely affect plaque vulnerability.”
Qian, C., Zhou, F., Lu, D.-D., Huang, J., & Sun, M. (2024) · BMC Public Health · doi:10.1186/s12889-024-20498-6 · Cited by 5 · see citing works
“Furthermore, the findings of a recent study suggest that the exercise intensity, rather than volume, is associated with more coronary artery calcification (CAC) and plaque progression in senior endurance sportsmen [61].”
BackgroundCoronary atherosclerosis in athletes: recent insights and clinical considerations
Aengevaeren, V., Claessen, G., & Eijsvogels, T. (2024) · British Journal of Sports Medicine · doi:10.1136/bjsports-2023-107938 · Cited by 5 · see citing works
Self-citationHon, A., Hsu, J. J., Zambrano, A., Xia, Y., Lu, M.-M., Echeverri, D., Kalanski, S., Umar, S., Demer, L., & Tintut, Y. (2023) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2023.117198 · Cited by 5 · see citing works
Fit to a fault? The paradox of coronary artery disease in veteran athletes.
Fyyaz, S., & Papadakis, M. (2023) · European Heart Journal · doi:10.1093/eurheartj/ehad271 · Cited by 5 · see citing works
Frijters, E., Nathoe, H. M., Grobben, R. G., Broekhuizen, L., Rienks, R., & Velthuis, B. (2025) · BMJ Open · doi:10.1136/bmjopen-2025-100250 · Cited by 4 · see citing works
“30 This indicates that a repeat scan might be a reasonable option for CVRM of select personnel with a high-hazard occupation, such as military aircrew.”
Self-citationSung, D.-E., & Sung, K.-C. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13216523 · Cited by 4 · see citing works
Rojo-López, M. I., Bermúdez-López, M., Castro, E., Farràs, C., Torres, G., Pamplona, R., Lecube, A., Valdivieso, J. M., Fernández, E., Julve, J., et al. (2024) · Nutrients · doi:10.3390/nu16213607 · Cited by 3 · see citing works
Bjørkavoll-Bergseth, M., Erevik, C., Kleiven, O., Wiktorski, T., Auestad, B., Skadberg, Ø., Aakre, K., Eijsvogels, T., & Ørn, S. (2024) · Scandinavian Journal of Medicine & Science in Sports · doi:10.1111/sms.14667 · Cited by 4 · see citing works
“31 Importantly, as shown by Figure 3, individuals with atherosclerosis that did not exceed a high-power output remained at a relatively low cTnI level.”
BackgroundSelf-citationTonet, E., Arzenton, M., Pietri, M. D., Canovi, L., Lapolla, D., Sarti, A., Amantea, V., Raisi, A., Mazzoni, G., Campo, G. C., et al. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13072044 · Cited by 4 · see citing works
“This observation highlights the importance of considering the dose–response relationship between physical activity and cardiovascular health, as excessive exercise may paradoxically increase the risk of atherosclerosis and adverse cardiovascular events [21].”
BackgroundInfluentialSinclair, J., Dillon, S., Lowe, N. M., & Melia, A. (2023) · Life · doi:10.3390/life14010063 · Cited by 4 · see citing works
“Previous analyses have shown that exercise intensity plays an important role in the aetiology and management of cardiovascular disease and its risk factors [47].”
BackgroundPauwels, 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
Self-citationMcHugh, C., Boyd, K. S., & Wasfy, M. M. (2026) · Journal of science and medicine in sport · doi:10.1016/j.jsams.2026.01.006 · Cited by 3 · see citing works
Bradycardia in Athletes: Prevalence, Mechanisms, and Risks
D'Ambrosio, P., de Paepe, J., Spencer, L. W., Ohanian, M., Janssens, K., Mitchell, A. M., Flannery, M., Bekhuis, Y., Pauwels, R., Delpire, B., et al. (2025) · Circulation · doi:10.1161/circulationaha.125.076170 · Cited by 3 · see citing works
“20,21 Cardiopulmonary Exercise Test Cardiopulmonary exercise testing was conducted on an electronically braked cycle ergometer (Lode, Groningen, the Netherlands) using a standardized continuous ramp protocol comprising 1 minute at 50 W followed by a progressive increase of 30 W/min until volitional…”
Li, Z., Luo, S., Bai, X., Huang, L., & Wang, D. (2025) · Journal of Sports Sciences · doi:10.1080/02640414.2025.2544433 · Cited by 3 · see citing works
Feuchtner, G., Ruf, E., Barbieri, F., Senoner, T., Deeg, J., Scharll, Y., Widmann, G., & Lacaita, P. (2025) · American Journal of Preventive Cardiology · doi:10.1016/j.ajpc.2025.101044 · Cited by 3 · see citing works
Widacha, L., Szramel, J., Nieckarz, Z., Kurpińska, A., Smolenski, R. T., Chłopicki, S., Zoladz, J. A., & Majerczak, J. (2025) · Frontiers in Physiology · doi:10.3389/fphys.2025.1568060 · Cited by 4 · see citing works
Zhou, T., Yuan, C.-X., Shen, C., Chen, S.-F., Li, J., Huang, K.-Y., Yang, X.-L., Liu, X.-Q., Cao, J., Yu, L., et al. (2025) · Journal of Sport and Health Science · doi:10.1016/j.jshs.2025.101031 · Cited by 3 · see citing works
“38 (cid:2) 42 Moreover, research indicates that both the high volume and intensity of PA are associated with beneficial subclinical cardiovascular changes, such as coronary artery calcification (CAC) scores, 43,44 potentially leading to a subsequent ASCVD risk reduction.”
Dausin, C., Tironi, R. M., Cornelissen, V., Hespel, P., Willems, R., Haykowsky, M., Gerche, A. L., Claessen, G., & Foulkes, S. (2024) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2024.12.009 · Cited by 3 · see citing works
Managing chronic coronary syndrome: how do we achieve optimal patient outcomes?
Manolis, A. S., Manolis, T. A., & Manolis, A. S. (2024) · Expert Review of Cardiovascular Therapy · doi:10.1080/14779072.2024.2357344 · Cited by 5 · see citing works
“…of deleterious outcomes from CAD, but high-intensity endurance exercise of long duration has been associated with increased coronary artery calcium (CAC), an indicator of atherosclerosis [128,129], and with coronary plaques albeit without a rise in overall or CV death rate in the medium term [130].”
BackgroundSiegel, A. (2023) · American Journal of Medicine · doi:10.1016/j.amjmed.2023.02.007 · Cited by 3 · see citing works
Berge, K., Aengevaeren, V., Mosterd, A., Velthuis, B., Lyngbakken, M. N., Omland, T., Schalkwijk, C., & Eijsvogels, T. (2023) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000003152 · Cited by 3 · see citing works
“We used data from the Measuring Ath-letes ’ Risk of Cardiovascular Events 2 (MARC-2) Study (24) cohort, a 6-yr follow-up study of subclinical coronary atherosclerosis in middle-age and older male athletes.”
Self-citationWang, Y., Du, X., & Wang, Q. (2026) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2026.1746819 · Cited by 4 · see citing works
Exercise Volume and Coronary Artery Calcification: A Systematic Review
Ellingson, C. J., Singh, J., Shafiq, M. A., Mehta, N., Sultana, S., Neary, J. P., Zhan, Y., Ahmadi, A. A., Budoff, M. J., & Dehghani, P. (2025) · CJC Open · doi:10.1016/j.cjco.2025.12.009 · Cited by 2 · see citing works
“Although our systematic review focuses on exercise volume, we acknowledge that exercise intensity, although less thoroughly researched, may also play a role in CAC progression 4 ; this represents a limitation of our approach.”
Guy, J., Schnell, F., Cade, S., Doutreleau, S., Gerardin, B., Armero, S., Chagué, F., Hédon, C., Guérard, S., Ivanes, F., et al. (2025) · Scandinavian Journal of Medicine & Science in Sports · doi:10.1111/sms.70194 · Cited by 2 · see citing works
Li, H., Zhang, Z., Sun, M., & Xu, S. (2025) · Clinical Hypertension · doi:10.5646/ch.2025.31.e34 · Cited by 2 · see citing works
“This effect is particularly pronounced in older athletes, where the detection rate of atherosclerotic plaques and overall CAC burden are significantly elevated [79].”
Mechanistic Insights Into Reduced Arrhythmia Prevalence in Female Endurance Athletes.
D'Ambrosio, P., de Paepe, J., Rowe, S., Janssens, K., Mitchell, A. M., Puyvelde, T. V., Spencer, L., Bogaert, J., Ghekiere, O., Pauwels, R., et al. (2025) · JACC Clinical Electrophysiology · doi:10.1016/j.jacep.2025.05.023 · Cited by 2 · see citing works
Chomiuk, T., Kasiak, P., Mamcarz, A., & Śliż, D. (2025) · Reviews in cardiovascular medicine · doi:10.31083/rcm37493 · Cited by 2 · see citing works
“Findings suggest that it is worth paying attention to the intensity prescribed to athletes and cardiac patients at a high risk of developing CAD [49].”
Janssen, S. L., Aengevaeren, V., de Vries, F., Kleinnibbelink, G., Mingels, A. M. A., Hopman, M., Mosterd, A., Velthuis, B., Riksen, N., & Eijsvogels, T. (2025) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000003674 · Cited by 2 · see citing works
“However, recent studies found a higher prevalence of coronary atherosclerosis among lifelong recreational athletes compared with sedentary peers (4 – 8), which was related to higher lifelong exercise volumes (4,9) and training at very vigorous exercise intensity (10,11).”
InfluentialSelf-citationSiegel, J. (2024) · American Journal of Medicine · doi:10.1016/j.amjmed.2024.11.032 · Cited by 2 · see citing works
Cardiovascular risk factors among endurance masters athletes from Switzerland.
Vine, M., Daucourt, C., Besson, C., Neyroud, D., Kayser, B., Meyer, P., Graf, G., Gabus, V., Gremeaux, V., Muller, O., et al. (2024) · European Journal of Preventive Cardiology · doi:10.1093/eurjpc/zwae287 · Cited by 2 · see citing works
Díaz-González, L., de la Guía-Galipienso, F., Carro, A., la Garza, M. S.-D., Madaria, Z., Serratosa, L., Masiá, M. D., & Boraíta, A. (2024) · REC: CardioClinics · doi:10.1016/j.rccl.2024.03.003 · Cited by 2 · see citing works
Coronary Artery Disease in Athletes-Insights from Cardiac CT
Khan, M. A., Ichikawa, K., Krishnan, S., & Budoff, M. (2025) · Journal of Clinical Cardiology · doi:10.33696/cardiology.6.064 · Cited by 2 · see citing works
“An opposite trend was observed in the MARC -2 (Measuring Athletes’ Risk of Cardiovascular Events 2) study, a longitudinal study investigated the relationship between exercise volume and intensity and the progression of coronary atherosclerosis using both CAC and coronary CTA [26].”
Sanchis-Gomar, F., Pérez-Quilis, C., Eijsvogels, T., la Guía-Galipienso, F., Christle, J., Perez, M., & Lavie, C. (2023) · Heart and Mind · doi:10.4103/hm.hm-d-23-00005 · Cited by 2 · see citing works
Self-citationDineen, E. H., Haigney, M., Levine, B. D., Ackerman, M., Baggish, A. L., Batts, T. C., Braverman, A. C., Chung, E. H., Cole, G. J., Cornwell, W. K., et al. (2026) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2026.07.003 · Cited by 1 · see citing works
Self-citationTetaj, N., Segreti, A., Pelullo, M., Rossi, C., Spagnolo, A., Ligorio, V., Ferro, A., Lentini, A. E., Trunfio, T. A., Ciancio, M., et al. (2026) · Journal of Functional Morphology and Kinesiology · doi:10.3390/jfmk11030265 · Cited by 1 · see citing works
“Interestingly, exercise volume during follow-up was not associated with progression, whereas exercise intensity appeared more informative: vigorous exercise was associated with less CAC progression, while very vigorous exercise was associated with greater CAC and calcified plaque progression [29].”
InfluentialCoronary Artery Disease in Masters Athletes: A Systematic Review
Gill, S., Singh, K., Malliaropoulos, N., & Kouidi, E. (2026) · Sports Medicine · doi:10.1007/s40279-026-02429-0 · Cited by 1 · see citing works
“Follow-up analyses revealed exercise inten-sity—rather than volume—to be more strongly associated with elevated CAC and subsequent plaque formation [51].”
Griffin, F., Fridolfsson, J., Arvidsson, D., Ekblom-Bak, E., Ekblom, Ö., Bergström, G., & Börjesson, M. (2025) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2025.120550 · Cited by 1 · see citing works
“Although higher physical activity generally correlates with lower atherosclerotic risk [32], studies in athletes have reported higher plaque burden [33,34], without necessarily exhibiting more high-risk features [35], suggesting that CRF may influence plaque characteristics in nuanced ways.”
Peng, J., Chang, Z., Wang, J., Liao, Z., Yang, Y.-J., Mu, L., Wang, S., Huang, J.-H., Xia, J.-B., & Hu, M. (2025) · Frontiers in Physiology · doi:10.3389/fphys.2025.1608268 · Cited by 1 · see citing works
Vilela, E., Almeida, M. C., Oliveira, C., Nogueira, T., Torres, S., Teixeira, M., Sampaio, F., Ribeiro, J., Oliveira, M., Bettencourt, N., et al. (2024) · Porto Biomedical Journal · doi:10.1097/j.pbj.0000000000000273 · Cited by 1 · see citing works
Atherosclerosis Prevalence among Different Physical Activity Patterns in Adult Men
Perez-Lasierra, J. L., Casajús, J., González-Agüero, A., Casasnovas, J., Torrijo-Blanche, C., Gimeno-Ruiz, S., & Moreno-Franco, B. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13175062 · Cited by 1 · see citing works
“However, despite the high-quality methodology used to assess the PA level in this study, as well as in other previous studies that used different and more subjective methods to assess PA, the assessment was limited to the baseline, and PA can vary greatly during the life course.”
ResultXiao, Z., Huang, G.-L., Li, G.-H., Wang, H., Zheng, X., Li, Y., Gong, F.-Y., Lv, Y., & Li, J.-J. (2024) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2024.1344764 · Cited by 1 · see citing works
Coronary heart disease in young individuals: novel ways to detect, prevent and treat
Mody, R., Dash, D., Mody, B., & Dash, U. (2024) · Journal of Transcatheter Interventions · doi:10.31160/jotci202331a20230015
Goldstein, M., & Mascitelli, L. (2024) · Medical Hypotheses · doi:10.1016/j.mehy.2023.111251 · Cited by 1 · see citing works
Identifying a high-risk fighter in boxing
Sethi, N. K. (2023) · MOJ Sports Medicine · doi:10.15406/mojsm.2023.06.00153 · Cited by 1
Association between DII and all-cause mortality among older adults with coronary heart disease
Wang, N.-N., Chen, X.-J., Li, H.-R., & Qi, C.-M. (2026) · Medicine · doi:10.1097/md.0000000000051350
“[7] Chronic low-grade inflammation is considered an important pathological mechanism in the occurrence and progression of CHD. [8] Diet, as a modifiable environmental factor, plays a crucial role in the development and maintenance of systemic inflammatory status.”
Luvianto, J., & Suastika, L. (2026) · Cardiology in Review · doi:10.1097/crd.0000000000001503
Exercise, Atherosclerosis, and Cardiovascular Outcomes: Evidence and Challenges
Dehesh, M., Hosseini, R., Ali, R., Kaur, J., & Villines, T. C. (2026) · Journal of Cardiovascular Development and Disease · doi:10.3390/jcdd13100479
Danielian, A., & Singh, S. (2026) · Current Treatment Options in Cardiovascular Medicine · doi:10.1007/s11936-026-01153-2
Garba, D. L., Zahid, S., Blumenthal, R., & Barouch, L. A. (2026) · American Journal of Preventive Cardiology · doi:10.1016/j.ajpc.2026.101735
Coronary Artery Disease in Male Athletes—Is Sport Healthy in the Long Run?
Kampka, Z., & Wybraniec, M. (2026) · Journal of Clinical Medicine · doi:10.3390/jcm15145329
“No such association was found in sportsmen engaging in less vigorous (6 to 9 METs) exercise [34].”
Higher skeletal muscle mass is associated with higher blood pressure and left ventricular mass
Shantsila, E., Shantsila, A., Sperrin, M., Gao, Z.-Z., Zheng, Y., Wilkinson, I., Leeson, P., Buchan, I., & Lip, G. (2026) · Journal of Hypertension · doi:10.1097/hjh.0000000000004375
“Study visits involved an initial assessment visit in 2006–2010, and three follow-up visits at 2012–2013 (follow-up visit ), 2014 + (follow-up visit 2) and 2019+ (follow-up visit 3).”
Zhang, X., Li, S., Mai, Y., Chen, H., Wu, H., Li, C., Zhao, L., & Peng, J. (2026) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2026.1847561
“This inconsistency lies at the heart of the J-curve debate, and exercise intensity may matter more than volume: in MARC-2, very high-intensity exercise was associated with calcification progression, while high-intensity (but not extreme) exercise correlated with reduced progression (15).”
Atherosclerosis Prevalence: Scoping Review with ☸️SAIMSARA
SAIMSARA (2026) · SAIMSARA Journal · doi:10.62487/saimsara4cd28ee4
Xia, Q., Tang, J., Casas-Martinez, J. C., Li, P., Borja-Gonzalez, M., Quinlan, L. R., Goljanek‐Whysall, K., & McDonagh, B. (2026) · FEBS Journal · doi:10.1111/febs.70502 · Cited by 1 · see citing works
WITHDRAWN: Reassessing the link between PA and CKD in CMD patients.
Gao, D.-X. (2025) · Journal of Science and Medicine in Sport · doi:10.1016/j.jsams.2025.10.015
RetractedContemporary management of calcified coronary artery disease
Senguttavan, N. B., Ramakumar, V., Naik, N., Kini, A., & Sharma, S. K. (2025) · Indian Heart Journal · doi:10.1016/j.ihj.2025.09.007
Self-citationKnechtle, B., Đurić, S., Scheer, V., Nikolaidis, P. Τ., Chlíbková, D., Leite, L. B., Čuk, I., Forte, P. M., Wilhelm, M., Weiss, K., et al. (2025) · Sports Medicine and Health Science · doi:10.1016/j.smhs.2025.07.011
“46 The possibility that long-term, high-volume training may increase coronary atherosclerosis 40,43,44,46 remains controversial, especially in Masters' athletes.”
InfluentialXia, Q., Tang, J.-W., Casas-Martinez, J. C., Li, P., Quinlan, L. R., Goljanek-Whysall, K., & McDonagh, B. (2025) · bioRxiv · doi:10.1101/2025.05.13.653755
Record-Breaking Endurance of 366 Marathons in 366 Days: A Case Study
de Souza, F. R., Lópes, R. D., da Fonseca, G. W. P., Barretto, R. B. D. M., Filho, A. C. B., do Val, R. M., Filho, R. K., & Alves, M. J. D. N. N. (2025) · Arquivos Brasileiros de Cardiologia · doi:10.36660/abc.20240838 · Cited by 3 · see citing works
Calcific versus non-calcific plaque: a CAD-RADS and FFRCT study
Murphy, D., Graby, J., Hudson, B., Lowe, R., Carson, K., Kandan, S. R., McKenzie, D., Khavandi, A., & Rodrigues, J. C. L. (2024) · The International Journal of Cardiovascular Imaging · doi:10.1007/s10554-024-03281-x
Exercise and sports revisited: Is too much exercise bad for your heart?
Rio, P., & Cardim, N. M. (2024) · Revista Portuguesa de Cardiologia · doi:10.1016/j.repc.2024.05.005
Objective and Subjective Assessments of Exercise Burden in Masters Athletes Are Poorly CorrelatedPreprint
Lewis, J., Bentley, R. F., Connelly, K. A., Dorian, P., & Goodman, J. M. (2023) · medRxiv · doi:10.1101/2023.12.06.23299458
“In one report, exercise intensity was calculated based on data from a questionnaire validated in a clinical, non-athlete population (39).”
MethodJin, H., Wang, X., Dai, H., Tian, A.-X., Chen, B.-W., Wu, C., Zhang, X.-Y., Cui, J.-L., Wu, Y., Li, X., et al. (2023) · Reviews in cardiovascular medicine · doi:10.31083/j.rcm2410285
“Notably, in our large-scale study, information on medication and intensity and duration of LTPA was collected, and the latter was quantified as MET-min/week according to the intensity and duration of certain activities, making the results more robust [24].”
MethodFrom the editor: Intensive exercise and insights from women.
Guyton, J. (2023) · Journal of Clinical Lipidology · doi:10.1016/j.jacl.2023.01.002
- Authors
- 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.
- Affiliations
- Radboud University Medical Center (NL)
- Meander Medisch Centrum (NL)
- Isala (NL)
- University Medical Center Utrecht (NL)
- St George's, University of London (GB)
- Hartford Hospital (US)
- ORCID
- Venue
- Circulation
- Published
- 2023-03-28
- Volume
- 147
- Issue
- 13
- Pages
- 993-1003
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W4313489140
- Cited by
- 115
- References
- 37
- Citations by year
- 2026: 22 · 2025: 33 · 2024: 37 · 2023: 23
- FWCI
- 22.67
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Circulation (publishedVersion, cc-by)
- PubMed (publishedVersion)
- St George's Online Research Archive (St George's University of London) (submittedVersion)
- Radboud Repository (Radboud University) (submittedVersion)
- Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
- Radboud Repository (Radboud University) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Effects of Exercise
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Keywords
- exercise volume, exercise intensity, coronary artery disease, coronary artery calcification, atherosclerotic plaque, high-intensity exercise, metabolic equivalent hours, cardiovascular risk, coronary CT angiography, male athletes, lifelong physical activity
- MeSH terms
- Aged, Coronary Artery Disease, Coronary Vessels, Cross-Sectional Studies, Humans, Male, Middle Aged, Risk Factors, Tomography, X-Ray Computed, Coronary Angiography, Athletes, Plaque, Atherosclerotic, Vascular Calcification
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