Relationship of exercise to coronary artery disease extent, severity and plaque type: A coronary computed tomography angiography study

Abstract

Background: While exercise has been associated with favorable coronary artery disease (CAD) outcomes, the relationship between endurance exercise levels and CAD findings has not been well explored.

Purpose: To evaluate the relationship of endurance exercise to CAD findings by coronary computed tomographic angiography (CCTA).

Methods: We evaluated consecutive patients referred to CCTA who filled out a survey instrument between 2015 and 2017, and who graded their level of weekly endurance exercise as: none, low (1-2 times per week), moderate (3-5 times per week) or high (5-7 times per week); along with the number of hours per week engaged in exercise as: low (<30 min), moderate (1 h) or high (>1-3 h). CCTA: analysis included measurement of maximum per-patient, per-vessel and per-segment stenosis severity, which was judged as minimal (<25%), mild (<50%), moderate (50-70%), and severe (>70%). CAD extent and severity was also summated CADRADS score, plaque burden by segment involvement score (SIS), and non-calcified plaque score (G-score). High-risk plaque (HRP), as defined by the presence of low attenuation plaque, positive arterial remodelling, spotty calcifications and napkin ring signs, was assessed. Finally, coronary artery calcium scores (CCS), as determined by Agatston units, were quantified.

Results: The study cohort comprised 252 patients (55.3y ±10.1, 39.7% females) with 97 inactives, 87 with low and 68 with moderate-to-high recreational endurance exercise levels (>=3x/week ≥ 1 h) included. Prevalence of subclinical CAD was 57.4%. Prevalence of >50% stenosis was with 13.2% lower at moderate-to-high exercise levels as compared to inactives (p = 0.04). Stenosis severity score (p = 0.04), total (p = 0.036) non-calcified plaque burden were lower (p = 0.026) in athletes, and in the absence of confounding risk factors, the effect strenghtened (SIS and G-score, p = 0.012 and 0.008). There was no difference in the CCS. High-risk plaque prevalence was higher in controls as compared to athletes with moderate-to-high exercise levels (13.4% vs 0%, p = 0.002), and HDL was lower (p < 0.001), respectively. MACE rate was 0%, and ICA rate of >50% stenosis 3.5% at 1 year follow-up.

Conclusion: Regular moderate-to-high endurance exercise results in lower total and non-calcified plaque burden and less high-risk plaque.