Evidence from international cohort studies has shown increased coronary atherosclerosis in male athletes vs controls,1 whereas data for female athletes are scarce and contradictory but likely not different from controls.1 A larger lifelong exercise volume and greater proportion of very vigorous intensity exercise training were identified as independent predictors of the prevalence and progression of coronary artery calcification scores (CACS) in males.2–4 Early studies hypothesised that accelerated calcification may represent plaque stabilisation as less harmful plaque phenotypes (ie, more calcified and less mixed plaques) were found in athletes vs controls.3 4 However, this concept was challenged by the Master@Heart study as lifelong male endurance athletes had a similar plaque morphology compared with non-athletes.5 These collective findings raise questions whether athletes should be worried about the development of coronary atherosclerosis and its clinical sequelae. Athletes have a better life expectancy compared with the general population with risk reductions for all-cause and cardiovascular mortality of ~30%–40%. Moreover, individuals with a higher cardiorespiratory fitness have a lower cardiovascular event rate for any given CACS compared with individuals with lower fitness.6 This may be partially attributable to a less harmful plaque composition. For example, in a UK cohort of 106 male master athletes (55±9 years old) without cardiovascular risk factors compared with 54 non-athletic controls, athletes had more calcified and less mixed plaque morphology,3 which are known to be less rupture prone.7 These findings were reinforced by the Dutch Measuring Athletes’ Risk of Cardiovascular Events (MARC) study, consisting of 318 recreational male athletes (aged …

中文翻译：

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运动员冠状动脉粥样硬化：最新见解和临床考虑

国际队列研究的证据表明，与对照组相比，男性运动员的冠状动脉粥样硬化有所增加，1 而女性运动员的数据很少且相互矛盾，但可能与对照组没有什么不同。1 终身运动量更大，高强度运动训练比例更高作为男性冠状动脉钙化评分 (CACS) 患病率和进展的独立预测因子。2-4 早期研究假设，加速钙化可能代表斑块稳定，因为在男性中发现了危害较小的斑块表型（即更多钙化和更少混合斑块）。运动员与对照组。3 4 然而，这一概念受到了 Master@Heart 研究的挑战，因为终身男性耐力运动员与非运动员相比具有相似的斑块形态。5 这些集体发现提出了运动员是否应该担心冠状动脉疾病发展的问题。动脉粥样硬化及其临床后遗症。与普通人群相比，运动员的预期寿命更长，全因死亡率和心血管死亡率的风险降低约 30%–40%。此外，与健康状况较低的个体相比，心肺健康状况较高的个体对于任何给定的 CACS 的心血管事件发生率均较低。6 这可能部分归因于危害性较小的斑块成分。例如，在英国的一个由 106 名没有心血管危险因素的男性大师运动员（55±9 岁）组成的队列中，与 54 名非运动对照组相比，运动员的钙化程度更高，混合斑块形态更少，3 已知这些斑块形态不易破裂。 .7 荷兰测量运动员心血管事件风险 (MARC) 研究强化了这些发现，该研究由 318 名休闲男性运动员（年龄……