City Research Online

Abstract

Exercise purports irrefutable cardiovascular morbidity and mortality benefits. Some male master endurance athletes demonstrate high coronary artery calcium scores, and increased prevalence of atherosclerotic plaques and myocardial fibrosis, which translate to increased risk of adverse events in the general population. This PhD explores the role of exercise dose, sporting discipline, blood pressure and diet in the development of coronary artery disease and myocardial fibrosis in this cohort.

220 male master endurance athletes aged 40-65 years, free of known cardiovascular risk factors, symptoms or coronary disease, who exercise for at least 6 hours/week, underwent clinical evaluation including CT calcium scoring and coronary angiography, cardiovascular MRI, 24-hour ambulatory BP monitoring and cardiopulmonary exercise testing.

38% demonstrated ambulatory hypertension and 35% a hypertensive response to exercise (≥220mmHg).

The data demonstrates a greater number of years participating in endurance exercise predicts more coronary calcium (OR 1.04, CI 1.01-1.08) and non-ischaemic myocardial fibrosis (OR 1.04 CI 1.01-1.08). A higher ambulatory systolic BP predicts stenosis >50% in a main vessel (ORadjusted 1.79, CI 1.20-2.66) partially calcified and non-calcified plaque (RRRadjusted 1.5, CI 1.16-1.97) and plaque vulnerability markers (ORadjusted 1.34 (1.06-1.71) and cyclists were more likely to have more stenoses >50% (p = 0.008) and partially calcified and non-calcified (p = 0.02) than multi-endurance athletes and more plaque vulnerability markers than runners and multi-endurance athletes (p = 0.03). Systolic ambulatory BP and maximal systolic exercise BP predict for ischemic myocardial fibrosis (ORunadjusted=1.07 CI 1.006-1.128 and ORadjusted=1.05 CI 1.006-1.109 respectively).

This thesis advances the understanding of the impact of chronic endurance exercise on the cardiovascular system of male master athletes. It demonstrates that hypertension is prevalent in master male athletes and highlights the importance of its evaluation for identifying athletes who may harbour more prone to vulnerable coronary disease.

Publication Type:	Thesis (Doctoral)
Subjects:	R Medicine R Medicine > RC Internal medicine R Medicine > RC Internal medicine > RC1200 Sports Medicine
Departments:	School of Health & Medical Sciences > Cardiovascular and Genomics Research Institute School of Health & Medical Sciences > School of Health & Medical Sciences Doctoral Theses Doctoral Theses

Export

Downloads