Perspective:

There is ongoing debate about the relationship between long-term endurance exercise and coronary heart disease risk. This prospective, observational study found that lifelong endurance athletes had more coronary plaques compared to healthy and active nonathletes, including more noncalcified plaques and more noncalcified proximal plaques; however, it did not address atherosclerotic coronary clinical events. In this study, all athletes were men, and the predominance were cyclists (77% cyclists or mixed cyclist/runners); potentially limiting extrapolation of the results to other populations. Further, although the presence of plaques was greater among athletes compared to healthy and active nonathletes, the overall plaque burden still was low. Regular exercise is known to improve blood pressure control and lipid profiles, to reduce the incidence of diabetes and myocardial infarction, and to increase life expectancy. Inasmuch as this study provides a cautionary note about endurance athletics and coronary plaque presence, an active lifestyle still should be encouraged, and additional cardiac clinical events still should guide exercise recommendations.