Endurance exercise and cardiac risk

As a lifelong endurance athlete, I found this disappointing: lifelong endurance athletes had much worse atherosclerosis and plaque than non-exercisers who lived a “healthy lifestyle” whatever that means.
“ Lifelong endurance athletes had more coronary plaques, including more non-calcified plaques in proximal segments, than fit and healthy individuals with a similarly low cardiovascular risk profile.”


I didn’t read the article but this finding isn’t new. Endurance athletes however in other research had lower overall mortality than sedentary peers (the best predictor for all cause mortality still is vo2max)


Somewhere I heard that plaques tend to form in regions that get stress (as in experience higher pressure). Thus, it’s not surprising that endurance athletes have more plaques, since their arteries regularly experience more pressure.

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If I recall correctly, endurance athletes have an elevated risk of atrial fibrilation as well. Telemisartan may be helpful as a preventative. To avoid ASCVD we want to keep APO-b low, and keep arterial inflammation low. Exercise just might be the very best intervention we have for remaining insulin sensitive and lowering inflammation generally. There are risks, but I will be getting on my bicycle and getting my heart rate up to 180 bpm later today.


I put this on another thread, but there is an issue about stress. I see three different cell level responses to stress HIF 1 alpha, NRF2 and NF kappa B. HIF 1 alpha is a rebuild response to lower amounts of stress, NRF 2 is middle territory (anti oxidants etc) and NF kappa B brings in the fighting response.

Too much NF kappa B is bad news. It is that situation which I think means endurance athletics has a disadvantage compared to people doing some exercise, but not as much.

Stress tends to be seen at a cellular level as hypoxia.

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Do you know the response of NF Kappa b to various training levels? For example: Would I expect NF Kappa b to be elevated during a 50 second sprint at a heart rate of 180 bpm, but not elevated during an hour long zone 2 ride at a heart rate of only 140 bpm? The training method advocated by fitness experts is more short intervals of high intensity rather than sustained high intensity.

i have already reduced marathons because of the danger of scar tissue in the heart. My ApoB was 64 at last measurement so I guess I’m good for a few more.

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Another potential factor is that some studies showed endurance athletes have elevated Lp(a) levels, as much as double. However in the meta analysis posted in one of the other Lp(a) threads they argued that it wasn’t conclusive due to lack of effect shown in other papers. It could be an issue, and if so it goes well with what you are discussing here, since elevated Lp(a) raises risk by 3-5x for different types of stenosis.

I’ve also been a little hesitant to keep doing a lot of marathons and ultras for reasons such as this, along with the potential for a-fib.

I’ve been thinking about this as well, as it seems that copious exercise (not five ultramarathons a week) and specifically resistance (for me: heavier weights, but then backpacking) is incredibly beneficial for longevity EXCEPT for risk of CVD due to stress. This along with my LDL is high for this forum (172) (although low for a keto or carnivore forum) and this probably Lpa, I have been thinking of regularly/periodically using Nattokinase or other plaque-reducing agents to decrease my risk here: by reducing the specific risk it should allow me to accumulate the other benefits. (But I guess I really won’t know until I am dead.)