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. 2025 Mar 3;26(3):461-470.
doi: 10.1093/ehjci/jeae317.

Predictors of coronary atherosclerosis in middle-aged and older athletes: the MARC-2 study

Kristian Berge  1   2   3 , Sylvan L J E Janssen  1 , Birgitta K Velthuis  4 , Peder Langeland Myhre  2   3 , Arend Mosterd  5 , Torbjørn Omland  2   3 , Thijs M H Eijsvogels  1 , Vincent L Aengevaeren  1   6
Affiliations

Predictors of coronary atherosclerosis in middle-aged and older athletes: the MARC-2 study

Kristian Berge et al. Eur Heart J Cardiovasc Imaging. .

Abstract

Aims: Exercise improves cardiovascular health, but high-volume high-intensity exercise is associated with increased coronary artery calcification (CAC). We aimed to identify predictors of CAC in athletes.

Methods and results: We assessed the association of traditional and non-traditional cardiovascular risk factors with CAC using linear and logistic regression. A total of 289 male athletes from the MARC-2 study were included, with a median age of 60 (Q1-3 56-66) years, lifelong weekly training load of 26 (17-35) metabolic equivalent of task hours, body mass index of 24.5 (22.9-26.6) kg/m2, systolic blood pressure of 139 ± 18 mmHg, and reported 0.0 (0.0-8.0) smoking pack years. Thirty-one per cent had a CAC score > 100 and 13% > 400. Among traditional cardiovascular risk factors, higher age, systolic blood pressure, smoking pack years, and family history of coronary artery disease independently predicted greater CAC scores, while body mass index, low-density lipoprotein cholesterol, and diabetes mellitus did not. Among non-traditional risk factors, higher training loads, serum phosphate, and lower adjusted energy intake and fat percentage of energy intake independently predicted greater CAC scores. The full model with all traditional and non-traditional risk factors had higher accuracy in predicting CAC > 100 [receiver operating characteristic area under the curve 0.76, 95% confidence interval (0.70-0.82)] and CAC > 400 [0.85 (0.77-0.92)] than traditional cardiovascular risk factors alone [0.72 (0.65-0.78), P = 0.012, and 0.81 (0.74-0.90), P = 0.038, respectively].

Conclusion: Non-traditional risk factors, including training load, dietary patterns, and serum phosphate, were independently associated with CAC in aging male athletes. Prediction accuracy for CAC increased when including these variables in a prediction model with traditional risk factors.

Keywords: coronary artery disease; exercise; risk prediction; training.

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Conflict of interest statement

Conflict of interest: K.B. has received speaker honoraria from Boehringer Ingelheim, Amgen, and Novartis. A.M. reports serving as a consultant for Bayer, Merck, Novartis, and Pfizer, receiving speaker honoraria from Novartis. B.K.V. reports serving as a regular speaker for Philips Healthcare. All relationships are modest. P.L.M. has received research grants from AstraZeneca and speaker and/or consulting fees from Amarin, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Novartis, Novo Nordisk, Orion Pharma, Pharmacosmos, Vifor, and Us2.ai, all unrelated to this work. T.O. has received consultancy and speaker honoraria from Abbott Diagnostics, Roche Diagnostics, and Novartis and research support via Akershus University Hospital from Thermo Fisher BRAHMS, HyTest Ltd, Biomedica, Abbott Diagnostics, Novartis, Singulex, SomaLogic, and Roche Diagnostics. T.O. also has financial interests in Cardinor AS, which holds the license to commercialize secretoneurin. All relationships are modest. The other authors report no conflicts.

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