Exercise and Coronary Atherosclerosis

[am50em]

Physical activity and exercise training are effective strategies for reducing the risk of cardiovascular events, but multiple studies have reported an increased prevalence of coronary atherosclerosis, usually measured as coronary artery calcification, among athletes who are middle-aged and older. Our review of the medical literature demonstrates that the prevalence of coronary artery calcification and atherosclerotic plaques, which are strong predictors for future cardiovascular morbidity and mortality, was higher in athletes compared with controls, and was higher in the most active athletes compared with less active athletes. However, analysis of plaque morphology revealed fewer mixed plaques and more often only calcified plaques among athletes, suggesting a more benign composition of atherosclerotic plaques.

https://www.ahajournals.org/doi/10.1161 ... 119.044467

My CAC score is very high and this article gives possible explanation.

[find_bruce]

Interesting - have a cardiologist appointment soon & will raise it with him then

[foo on patrol]

I'm fortunate in that my calcium score was 1 when I had it checked 2yrs ago. You can be a skinny or healthy looking person but still be unhealthy on the inside and this is what most don't take into consideration.

Foo

[am50em]

My former GP (now retired) had calcium score of 1 and he ate butter by itself, full cream milk and no strict dieting. So definitely not necessarily diet related. My report gave calcium scores for 4 different places as 0, 45, 1100 and 1200! But stenosis only mild and no symptoms.

[Nobody]

Atherosclerosis is a big subject, full of anecdotes and contentious theories. About half the population (47%) has some kind of genetic susceptibility to getting it to some degree. Obviously there is a range within that. The ones that don't have the genetics often eat anything they like, get no increased risk results then boast about it. But they still don't live forever, so they succumb to something eventually. And it doesn't mean their risk proves anything about those with different genetics.

Anyway, above is not the first report that people who do intense exercise have thicker arteries and possibly higher measured blood pressures as a result. Some of it is considered adaption to the exercise intensity itself and may not be creating higher risk. Not enough research yet.
Too much high-intensity exercise may be bad for your health - SMH
Endurance exercise may affect body's largest artery differently in men and women - UCL

You can have a CAC of zero and still have atherosclerosis elsewhere. You can pretty much be assured that if you're middle aged and been eating a higher fat, higher cholesterol and/or higher salt diet all your life that there's a high change it's there somewhere.

My former GP (now retired) had calcium score of 1 and he ate butter by itself, full cream milk and no strict dieting. So definitely not necessarily diet related. My report gave calcium scores for 4 different places as 0, 45, 1100 and 1200! But stenosis only mild and no symptoms.

GPs generally know very little about diet, other than what's self taught. Which still could be wrong, like low carb. The problem is that the message some GPs spread to their patients is doing harm.

Yes atherosclerosis is definately diet related. Proven by the Framingham study which is still ongoing and multi-generational now. But as I said above, it doesn't affect all equally. Eat a heap of fat, cholesterol, salt, processed foods, sugars, oils etc and watch your blood test risk factors increase in weeks. I greatly increased my LDL cholesterol - I think it was increased by 1.9 mmol/L (a lot) - just by eating <100g/d of primarily "good fat" flax and chia seeds for some months.

[am50em]

The clinical manifestations of atherosclerosis are nowadays the main cause of death in industrialized countries, but atherosclerotic disease was found in humans who lived thousands of years ago, before the spread of current risk factors. Atherosclerotic lesions were identified on a 5300-year-old mummy, as well as in Egyptian mummies and other ancient civilizations. For many decades of the twentieth century, atherosclerosis was considered a degenerative disease, mainly determined by a passive lipid storage, while the most recent theory of atherogenesis is based on endothelial dysfunction.

Due to their anti-inflammatory and metabolic benefits, effective lifestyle interventions – such as Mediterranean diet, regular exercise, weight control and smoking cessation – are prescribed as a non-pharmacological treatment for atherosclerosis, preceding or accompanying drug therapy for reducing cardiovascular risk. In this regard, it should be noted that Tsimane – a Bolivian population conducting a subsistence lifestyle with few coronary risk factors – have the lowest prevalence of ischemic heart disease in the world, notwithstanding a high inflammatory burden.91

Many anti-inflammatory drugs, such as statins, antithrombotics and antihypertensives are widely used, but at most, they only delay the progression of atherosclerosis; therefore, new anti-atherosclerotic therapies that address the residual inflammatory risk are warranted.

The CANTOS (Canakinumab Anti-inflammatory Thrombosis Outcomes Study) trial demonstrated the effectiveness of targeting inflammation in atherosclerosis. Canakinumab - a therapeutic monoclonal antibody targeting interleukin-1β - led to a significantly lower rate of recurrent cardiovascular events than placebo in 10,061 patients who have sustained a previous myocardial infarction, with no significant difference in all-cause mortality.92,93

Interestingly, CANTOS was the first trial to prove the inflammatory hypothesis of atherothrombosis.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7398886/

[Nobody]

The Egyptian mummies mainly proves that it's a disease of affluence, since my understanding is only important people were mummified. These days many in affluent countries like this one can eat much like the richer Egyptians, or even worse at no significant extra cost. Yes atherosclerosis has been with us for a long time, but in the recent past you wouldn't find it in places like rural China and the poorer countries in Africa because they could barely afford to eat animal products and richer foods.

Intense exercise might be making the situation worse for some, at least in some measurable ways. Whether those measurable ways translates to a real risk, no one yet knows for sure. Maybe not. But intense exercise is known to induce heart attacks in some people, including pro cyclists. I don't do a lot of intense exercise anymore. When I did, my blood pressure was higher. These days I eat healthier and my BP is 95/65.

[am50em]

Atherosclerosis and vascular calcification are usually regarded as circulatory phenotypes associated with advanced modern lifestyles. However, although rare, such conditions have been identified in human remains from some early societies. Examples occur in an elite Chinese burial (c. 700 BCE), and among Canadian Eskimos (c. 400 CE to c. 1520 CE) whose diet was almost entirely meat. They have also been reported since the early 20th century in the mummified remains of the rulers and elite of ancient Egypt. Marc Ruffer described arterial lesions in hundreds of Egyptian mummies in 1911 and Graham Shattock noted atheromatous deposits in the aorta of King Menephtah in 1909; these findings were later confirmed by John Harris and Edward Wente's radiological survey in 1980, which additionally reported vascular calcification in the mummies of Ramesses II, Ramesses III, Sethos I, Ramesses V, and Ramesses VI.
More recent multidisciplinary investigations of mummified remains have provided evidence of arteriosclerosis among elite groups in Egyptian society, particularly those individuals with priestly status and their immediate family members. Last year, computed tomography was used to assess atherosclerosis in a selection of 22 mummies of Egyptians with high social status. In 16 of these where the hearts or arteries could be identified, nine mummies showed evidence of vascular calcification. However, although arteriosclerosis has been clearly identified in mummies, it seems to have been fairly uncommon in ancient Egypt. This perhaps reflects the life expectancy at the time of between 40 and 50 years, even among the more affluent members of society, but may also result from differences in intakes of foodstuffs between most Egyptians and the affluent elite.

https://www.thelancet.com/journals/lanc ... 2/fulltext

So die young and you don't have to worry about it.