Laura DeFina, MD President and Chief Executive Officer Chief Science Officer The Cooper Institute 

Endurance Athletes May Have More Coronary Artery Calcification But No Greater Risk Interview with:

Laura DeFina, MD President and Chief Executive Officer Chief Science Officer The Cooper Institute 

Dr. DeFina

Laura DeFina, MD
President and Chief Executive Officer
Chief Science Officer
The Cooper Institute What is the background for this study?

Response: Several studies suggest that endurance athletes may be at higher risk for asymptomatic hardening of the coronary arteries.  These studies, however, have been done on small numbers of endurance athletes (ie – marathon runners) and do not show whether this increase in hardening actually leads to increase in heart attacks or death of cardiovascular disease.

In our population of 21,758 generally healthy individuals (average age 52 years) who presented for a preventive medicine examination, we were able to evaluate for the presence of hardening and cardiovascular events in individuals who exercised high volumes (≥3000 MET·minutes/week or comparable to running 6 miles/hour for an hour 5 days a week) versus those exercising less. What are the main findings?

  1. There was an 11% greater risk of coronary artery calcification in those with the highest level of physical activity.
  2. However, in men with coronary artery calcification, there was no significant greater risk of all-cause or cardiovascular death after 10.4 years of follow-up. What should readers take away from your report?

Response: Very high levels of endurance physical activity may be associated with increased hardening of the coronary arteries but, in this population of otherwise healthy individuals, high physical activity in those with this hardening of the coronary arteries does not associate with greater risk of all-cause or cardiovascular disease.

Practically, this means that high-volume exercisers can feel re-assured that they can maintain their exercise program after consultation with their doctor to ensure that there is no other reason to decrease their exercise amount. What recommendations do you have for future research as a result of this work?

Response: Future research should include evaluating the impact of high volume exercise on hardening of the arteries and death in women but our population had too few events to be studied.

Additionally, more research into understanding why high-volume exercisers might have increased amounts of hardening of the artery. Is there anything else you would like to add? 

Response: Exercise should be part of everyone’s wellness program.  The 2018 Physical Activity Guidelines provide easy to understand recommendations.  Healthy behaviors, including regular physical activity, maintaining a healthy diet and weight, and not smoking, all can help lower the risk of developing cardiovascular disease.  Of course, one should always speak with their physician before embarking on a new exercise program.


DeFina LF, Radford NB, Barlow CE, et al. Association of All-Cause and Cardiovascular Mortality With High Levels of Physical Activity and Concurrent Coronary Artery Calcification. JAMA Cardiol. Published online January 30, 2019. doi:10.1001/jamacardio.2018.4628

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Last Updated on January 30, 2019 by Marie Benz MD FAAD