Guarnieri et al. 2025, Extreme endurance training and coronary artery disease: systematic review and meta-analysis

This PRISMA-guided systematic review and meta-analysis (MEDLINE, Embase, Scopus) found that endurance athletes show a higher prevalence of coronary atherosclerosis than non-athlete controls, but do not show a greater prevalence of high-risk or obstructive plaques. The authors conclude that the higher atherosclerosis burden in athletes reflects stable, densely calcified plaque rather than the vulnerable, soft plaques that precipitate acute cardiac events; continuous CAC scores did not significantly differ between athletes and controls. Evidence: moderate.