Sex Differences in the Impact of Exercise Volume on Subclinical Coronary Atherosclerosis: A Meta-Analysis

Ahmed Abdelaziz; Ahmed Elshahat; Ahmed Farid Gadelmawla; Muhammad Desouky; Abdelrahman H. Hafez; Mohamed Abdelaziz; Noha Hammad; Dua Eldosoky; Kirtipal Bhatia; Annalisa Filtz; Daniel Lorenzatti; Toshiki Kuno; Salim S. Virani; Martha Gulati; Michel D. Shapiro; Carl J. Lavie; Leandro Slipczuk

doi:10.1016/j.jacadv.2025.101786

Sex Differences in the Impact of Exercise Volume on Subclinical Coronary Atherosclerosis: A Meta-Analysis

Ahmed Abdelaziz, Ahmed Elshahat, Ahmed Farid Gadelmawla, Muhammad Desouky, Abdelrahman H. Hafez, Mohamed Abdelaziz, Noha Hammad, Dua Eldosoky, Kirtipal Bhatia, Annalisa Filtz, Daniel Lorenzatti, Toshiki Kuno, Salim S. Virani, Martha Gulati, Michel D. Shapiro, Carl J. Lavie, Leandro Slipczuk

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Abstract

Background: The effects of high-volume exercise on coronary atherosclerosis remain controversial. Objectives: The authors aimed to evaluate the impact of endurance exercise on coronary atherosclerosis assessed by cardiac computed tomography (CT) in athletes and nonathletes, and analyze differences based on sex. Methods: We searched PubMed, Scopus, Web of Science, and Cochrane Central for relevant studies from inception to September 2024, assessing the impact of different exercise volumes on subclinical coronary artery atherosclerosis assessed by coronary artery calcification (CAC) scoring or CT angiography (CCTA). The control group comprised nonathletes. The primary outcome was the difference in CAC scores between athletes and nonathletes and the secondary outcome was the differences in calcified plaque by CCTA. The analysis was stratified by sex and exercise volume assessed using metabolic equivalents of task (MET)-min/wk. Results: Nine observational studies including 61,150 participants were included in the analysis. Male athletes with an exercise volume of >3,000 MET-min/wk showed higher mean CAC scores than nonathlete males (mean difference = 31.62; 95% CI: 10.66-52.58; P < 0.001), while no difference in CAC was found for male athletes with 1,500 to 3,000 MET-min/wk (P = 0.93) or female athletes with an exercise volume of 1,500 MET-min/wk or greater (P = 0.39 and P = 0.07). Our secondary endpoint showed significant sex-specific differences on the association of exercise volume and calcified plaque number and volume by CCTA. Conclusions: Males with high-volume exercise training (>3,000 MET-min/wk) exhibited a higher burden of calcified plaque by CAC score than male nonathletes, while no such difference was observed in female athletes.

Original language	English (US)
Article number	101786
Journal	JACC: Advances
Volume	4
Issue number	6
DOIs	https://doi.org/10.1016/j.jacadv.2025.101786
Publication status	Published - Jun 2025

Keywords

CAC
athletes
cardiovascular risks
coronary artery calcium
exercise
sex differences
subclinical atherosclerosis

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10.1016/j.jacadv.2025.101786

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Abdelaziz, A., Elshahat, A., Gadelmawla, A. F., Desouky, M., Hafez, A. H., Abdelaziz, M., Hammad, N., Eldosoky, D., Bhatia, K., Filtz, A., Lorenzatti, D., Kuno, T., Virani, S. S., Gulati, M., Shapiro, M. D., Lavie, C. J., & Slipczuk, L. (2025). Sex Differences in the Impact of Exercise Volume on Subclinical Coronary Atherosclerosis: A Meta-Analysis. JACC: Advances, 4(6), Article 101786. https://doi.org/10.1016/j.jacadv.2025.101786

@article{1c9dd718b7294f35954bd0308290b053,

title = "Sex Differences in the Impact of Exercise Volume on Subclinical Coronary Atherosclerosis: A Meta-Analysis",

abstract = "Background: The effects of high-volume exercise on coronary atherosclerosis remain controversial. Objectives: The authors aimed to evaluate the impact of endurance exercise on coronary atherosclerosis assessed by cardiac computed tomography (CT) in athletes and nonathletes, and analyze differences based on sex. Methods: We searched PubMed, Scopus, Web of Science, and Cochrane Central for relevant studies from inception to September 2024, assessing the impact of different exercise volumes on subclinical coronary artery atherosclerosis assessed by coronary artery calcification (CAC) scoring or CT angiography (CCTA). The control group comprised nonathletes. The primary outcome was the difference in CAC scores between athletes and nonathletes and the secondary outcome was the differences in calcified plaque by CCTA. The analysis was stratified by sex and exercise volume assessed using metabolic equivalents of task (MET)-min/wk. Results: Nine observational studies including 61,150 participants were included in the analysis. Male athletes with an exercise volume of >3,000 MET-min/wk showed higher mean CAC scores than nonathlete males (mean difference = 31.62; 95\% CI: 10.66-52.58; P < 0.001), while no difference in CAC was found for male athletes with 1,500 to 3,000 MET-min/wk (P = 0.93) or female athletes with an exercise volume of 1,500 MET-min/wk or greater (P = 0.39 and P = 0.07). Our secondary endpoint showed significant sex-specific differences on the association of exercise volume and calcified plaque number and volume by CCTA. Conclusions: Males with high-volume exercise training (>3,000 MET-min/wk) exhibited a higher burden of calcified plaque by CAC score than male nonathletes, while no such difference was observed in female athletes.",

keywords = "CAC, athletes, cardiovascular risks, coronary artery calcium, exercise, sex differences, subclinical atherosclerosis",

author = "Ahmed Abdelaziz and Ahmed Elshahat and Gadelmawla, \{Ahmed Farid\} and Muhammad Desouky and Hafez, \{Abdelrahman H.\} and Mohamed Abdelaziz and Noha Hammad and Dua Eldosoky and Kirtipal Bhatia and Annalisa Filtz and Daniel Lorenzatti and Toshiki Kuno and Virani, \{Salim S.\} and Martha Gulati and Shapiro, \{Michel D.\} and Lavie, \{Carl J.\} and Leandro Slipczuk",

note = "Publisher Copyright: {\textcopyright} 2025 The Authors",

year = "2025",

month = jun,

doi = "10.1016/j.jacadv.2025.101786",

language = "English (US)",

volume = "4",

journal = "JACC: Advances",

issn = "2772-963X",

publisher = "Elsevier B.V.",

number = "6",

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Abdelaziz, A, Elshahat, A, Gadelmawla, AF, Desouky, M, Hafez, AH, Abdelaziz, M, Hammad, N, Eldosoky, D, Bhatia, K, Filtz, A, Lorenzatti, D, Kuno, T, Virani, SS, Gulati, M, Shapiro, MD, Lavie, CJ & Slipczuk, L 2025, 'Sex Differences in the Impact of Exercise Volume on Subclinical Coronary Atherosclerosis: A Meta-Analysis', JACC: Advances, vol. 4, no. 6, 101786. https://doi.org/10.1016/j.jacadv.2025.101786

TY - JOUR

T1 - Sex Differences in the Impact of Exercise Volume on Subclinical Coronary Atherosclerosis

T2 - A Meta-Analysis

AU - Abdelaziz, Ahmed

AU - Elshahat, Ahmed

AU - Gadelmawla, Ahmed Farid

AU - Desouky, Muhammad

AU - Hafez, Abdelrahman H.

AU - Abdelaziz, Mohamed

AU - Hammad, Noha

AU - Eldosoky, Dua

AU - Bhatia, Kirtipal

AU - Filtz, Annalisa

AU - Lorenzatti, Daniel

AU - Kuno, Toshiki

AU - Virani, Salim S.

AU - Gulati, Martha

AU - Shapiro, Michel D.

AU - Lavie, Carl J.

AU - Slipczuk, Leandro

PY - 2025/6

Y1 - 2025/6

N2 - Background: The effects of high-volume exercise on coronary atherosclerosis remain controversial. Objectives: The authors aimed to evaluate the impact of endurance exercise on coronary atherosclerosis assessed by cardiac computed tomography (CT) in athletes and nonathletes, and analyze differences based on sex. Methods: We searched PubMed, Scopus, Web of Science, and Cochrane Central for relevant studies from inception to September 2024, assessing the impact of different exercise volumes on subclinical coronary artery atherosclerosis assessed by coronary artery calcification (CAC) scoring or CT angiography (CCTA). The control group comprised nonathletes. The primary outcome was the difference in CAC scores between athletes and nonathletes and the secondary outcome was the differences in calcified plaque by CCTA. The analysis was stratified by sex and exercise volume assessed using metabolic equivalents of task (MET)-min/wk. Results: Nine observational studies including 61,150 participants were included in the analysis. Male athletes with an exercise volume of >3,000 MET-min/wk showed higher mean CAC scores than nonathlete males (mean difference = 31.62; 95% CI: 10.66-52.58; P < 0.001), while no difference in CAC was found for male athletes with 1,500 to 3,000 MET-min/wk (P = 0.93) or female athletes with an exercise volume of 1,500 MET-min/wk or greater (P = 0.39 and P = 0.07). Our secondary endpoint showed significant sex-specific differences on the association of exercise volume and calcified plaque number and volume by CCTA. Conclusions: Males with high-volume exercise training (>3,000 MET-min/wk) exhibited a higher burden of calcified plaque by CAC score than male nonathletes, while no such difference was observed in female athletes.

AB - Background: The effects of high-volume exercise on coronary atherosclerosis remain controversial. Objectives: The authors aimed to evaluate the impact of endurance exercise on coronary atherosclerosis assessed by cardiac computed tomography (CT) in athletes and nonathletes, and analyze differences based on sex. Methods: We searched PubMed, Scopus, Web of Science, and Cochrane Central for relevant studies from inception to September 2024, assessing the impact of different exercise volumes on subclinical coronary artery atherosclerosis assessed by coronary artery calcification (CAC) scoring or CT angiography (CCTA). The control group comprised nonathletes. The primary outcome was the difference in CAC scores between athletes and nonathletes and the secondary outcome was the differences in calcified plaque by CCTA. The analysis was stratified by sex and exercise volume assessed using metabolic equivalents of task (MET)-min/wk. Results: Nine observational studies including 61,150 participants were included in the analysis. Male athletes with an exercise volume of >3,000 MET-min/wk showed higher mean CAC scores than nonathlete males (mean difference = 31.62; 95% CI: 10.66-52.58; P < 0.001), while no difference in CAC was found for male athletes with 1,500 to 3,000 MET-min/wk (P = 0.93) or female athletes with an exercise volume of 1,500 MET-min/wk or greater (P = 0.39 and P = 0.07). Our secondary endpoint showed significant sex-specific differences on the association of exercise volume and calcified plaque number and volume by CCTA. Conclusions: Males with high-volume exercise training (>3,000 MET-min/wk) exhibited a higher burden of calcified plaque by CAC score than male nonathletes, while no such difference was observed in female athletes.

KW - CAC

KW - athletes

KW - cardiovascular risks

KW - coronary artery calcium

KW - exercise

KW - sex differences

KW - subclinical atherosclerosis

UR - https://www.scopus.com/pages/publications/105004905495

U2 - 10.1016/j.jacadv.2025.101786

DO - 10.1016/j.jacadv.2025.101786

M3 - Article

AN - SCOPUS:105004905495

SN - 2772-963X

VL - 4

JO - JACC: Advances

JF - JACC: Advances

IS - 6

M1 - 101786

ER -

Sex Differences in the Impact of Exercise Volume on Subclinical Coronary Atherosclerosis: A Meta-Analysis

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Keywords

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