This study used wearable device-derived training load data to investigate the relationship between exercise volume and coronary atherosclerosis in middle-aged and older athletes, addressing the paradox of increased coronary plaque in endurance athletes.
Background: Middle-aged and older endurance athletes have increased prevalence of coronary artery disease (CAD) on coronary CT angiography (CCTA) compared to healthy controls, despite similarly low cardiovascular risk. Prior studies relied on self-reported data to quantify training load (TL), which poorly correlates with objective wearable-derived TL and may bias outcomes. The impact of objective TL on CAD risk remains unknown.Methods: In this observational, cross-sectional analysis of the Master@Heart study, 222 males (median age 54 [49–59] years) were included: 77 lifelong athletes, 98 late-onset athletes, and 47 controls. TL was assessed using objective wearable-derived training duration and intensity (12 consecutive months), as well as self-reported training measures. CCTA-derived CAD prevalence was compared across TL quartiles (Q) using a global unadjusted chi-square test and logistic regression, adjusted for cardiovascular risk factors and years of endurance exercise, to estimate
