What? Intense Exercise Results in More Coronary Calcification But Keep Doing It

Physical activity and exercise training are associated with a lower risk for coronary events.

Puzzling for sure is that prior studies of middle-aged and older male athletes revealed increased coronary artery calcification (CAC) and atherosclerotic plaques, which were related to the amount and intensity of lifelong exercise.

Does exercise actually drive the degree of calcified plaque in arteries upwards? And what aspect of exercise?  New data show that the intensity of exercise over 6 years related to increased calcification and plaque in heart arteries although risk is low. 

Middle-aged and older men from the MARC-1 (Measuring Athlete's Risk of Cardiovascular Events 1) study were invited for follow-up in MARC-2 (Measuring Athlete's Risk of Cardiovascular Events 2) study. The prevalence and severity of CAC and plaques were determined by coronary computed tomography angiography.

The volume (metabolic equivalent of task [MET] hours/week) and intensity (moderate [3 to 6 MET hours/week]; vigorous [6 to 9 MET hours/week]; and very vigorous [≥9 MET hours/week]) of exercise training were quantified during follow-up. 


Overall, 289 of the original 318 men in a trial called MARC-1 completed repeat heart imaging  at a follow-up of 6.3 years. Participants exercised for 41 (25 to 57) MET hours/week during follow-up, of which 0% was at moderate intensity, 44% was at vigorous intensity, and 34% was at very vigorous intensity.

Prevalence of CAC increased from 52% to 71% during the follow-up. CAC  was  present  in  151  (52%)  men  at  baseline  and  increased  to  205  (71%)  men  at  follow-up.  CAC  scores  ≥100  increased  from  15%  to 31%, CAC scores ≥400 increased from 6% to 13%, and  CAC  scores  ≥1000  increased  from  1%  to  6%  at follow-up.

Plaque prevalence increased from 64% at baseline to 83% at follow-up. A total of 216 (75%) participants showed an increased number of  coronary  atherosclerotic plaques.

Exercise volume during follow-up was not associated with changes in CAC or plaque.

Very vigorous intensity exercise was associated with a greater increase in CAC score. Very vigorous exercise was also associated with increased odds of plaque progression.


Exercise intensity but not volume was associated with progression of coronary atherosclerosis during 6-year follow-up.

It is intriguing that very vigorous intensity exercise was associated with greater CAC and calcified plaque progression, whereas vigorous intensity exercise was associated with less CAC progression.

The  effect  of  very  vigorous  intensity  exer-cise may mimic the effect of statins on CAC and plaque composition.   Statins   increase   plaque   calcification   in   some studies,33 but decrease atheroma volume and car-diovascular risk.

Further studies will be needed to assess if moderate exercise is the optimal sweet spot for CAC and plaque as well as any events these participants may have.


Dr. Joel Kahn

You Might Also Enjoy...