Carotid atherosclerosis and aortic stiffness in masters athletes: Multimodality vascular phenotyping from the Master@Heart study

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Background Middle-aged male Masters athletes exhibit a higher burden of coronary atherosclerosis on coronary computed tomography angiography (CCTA) compared with healthy controls. Whether this is accompanied by differences in carotid atherosclerosis or aortic stiffness remains uncertain. We assessed carotid atherosclerosis and aortic stiffness across groups, association between carotid atherosclerosis and coronary disease, and the incremental value of carotid plaque beyond traditional risk factors. Methods In this cross-sectional analysis of the Master@Heart study, 549 low cardiovascular risk men (median age 55 [50–60] years), including lifelong athletes, late-onset athletes, and healthy controls, underwent vascular phenotyping. Carotid plaque was assessed by ultrasound, aortic stiffness by carotid–femoral pulse wave velocity (PWV), and coronary atherosclerosis by CCTA. Group differences were assessed using chi-square and Kruskal–Wallis tests. Association between carotid and coronary atherosclerosis was evaluated using regression models. Incremental discriminatory value was assessed using ROC curve analysis. Results Prevalence of ≥1 carotid plaque did not differ between lifelong athletes, late-onset athletes, and controls (29.5% vs. 33.2% vs. 27.9%; p=0.54). Carotid stenosis ≥50% was rare (1.2%–2.7%) and similar across groups (p=0.54). Median PWV did not differ between groups (p=0.29). Carotid plaque was associated with coronary atherosclerosis on CCTA. However, adding carotid plaque to traditional risk factors did not improve discrimination of coronary atherosclerosis. Conclusion In middle-aged male Masters athletes, excess subclinical coronary atherosclerosis is observed without corresponding differences in carotid plaque or aortic stiffness. Although carotid plaque is associated with coronary atherosclerosis, it does not meaningfully improve risk discrimination beyond traditional risk factors.

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