Exercise and physical activity reduce the risk of cardiovascular disease (CVD). It has been observed that an active individual is at a 30% to 40% lower risk of CVD. However, previous cross-sectional studies have failed to determine whether exercise has a significant impact on expediting coronary atherosclerosis and plaque morphology. A recent Circulation journal paper has focused on investigating the relationship between exercise volume and intensity and the progression of coronary atherosclerosis in middle-aged and older male athletes.

The current study used CAC scoring and CCTA to evaluate the relationship between exercise training characteristics and coronary atherosclerosis in middle-aged and older male athletes. This study hypothesized that greater volume and intensity of exercise are associated with a higher incidence of coronary atherosclerosis.

The present study is known as the MARC-2 (Measuring Athletes’ Risk of Cardiovascular Events 2), a follow-up of the MARC-1 (Measuring Athletes’ Risk of Cardiovascular Events 1) study.

The MARC-2 study recruited asymptomatic middle-aged and older men above 45 years of age and did not show any abnormalities in their sport’s medical evaluation between May 2019 and February 2020. Individuals who underwent a percutaneous coronary intervention during follow-up were excluded.

Relevant information about the exercise characteristics of the participants was obtained via a validated questionnaire. This questionnaire focussed on collecting information about the type of sport, frequency, the duration for each sport (in years), duration of an exercise session, and level of performance, i.e., recreational vs. competitive, of the study cohort.

A metabolic equivalent of task (MET) for all reported sports was assigned based on the Compendium of Physical Activities. The current study used exercise volume, expressed in MET hours/week, during the study period.

Over the 6-year follow-up period, exercise intensity was associated with the progression of coronary atherosclerosis, but not exercise volume. It is noteworthy that very vigorous intensity exercise was associated with significantly higher CAC and calcified plaque progression, whereas vigorous intensity exercise was associated with less CAC progression.