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Your athlete-patient has a high coronary artery calcification score—‘Heart of Stone’. What should you advise? Is exercise safe?
  1. Katharina Lechner1,
  2. Bianca Spanier1,
  3. Benjamin Lechner2,
  4. Johannes Scherr1,3
  1. 1 Department of Prevention and Sports Medicine, Technical University Munich, Munich, Germany
  2. 2 Department of Internal Medicine IV, Ludwig Maximillians University Munich, Munich, Germany
  3. 3 University Center for Preventive and Sports Medicine, Balgrist University Hospital, University of Zurich, Zürich, Switzerland
  1. Correspondence to Dr Katharina Lechner, Department of Cardiology, German Heart Center, Technical University Munich, Lazarettstraße 36, 80636 München, Germany; contact{at}

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Coronary artery calcification (CAC) is a strong marker of subclinical coronary atherosclerosis and leading authorities recommend CAC scoring to help inform patient management decisions in cardiovascular disease (CVD) prevention.1 2 This will result in an increasing number of athlete-patients with subclinical coronary atherosclerosis presenting to sport and exercise medicine physicians, raising questions about exercise recommendations in this subgroup. With a specific focus on the recent outcomes data of DeFina and colleagues3 we extend our recent discussion of the topic2 by focusing on how to manage athlete-patients with elevated CAC in the sport and exercise medicine setting.

Physical activity, coronary artery calcium and cardiovascular outcomes—higher physical activity protects at every level of CAC

A breakthrough in reporting the association of CAC and mortality risk across different activity levels came from a recent study of 21 758 healthy male participants without prevalent CVD. Higher levels of leisure-time physical activity were associated with a lower risk of mortality at any given level of CAC.3 The authors reported a higher risk metabolic profile (ie, higher baseline blood pressure, higher glucose concentrations and higher triglycerides) in the high volume exercise group with elevated CAC ≥100 AU …

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  • Contributors All authors contributed to this discussion. KL did the literature search, and drafted the manuscript. BS, BL and JS reviewed and edited the manuscript. All authors approved the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.