Middle-aged endurance athletes often show coronary artery disease on CCTA. They match low-risk controls in CV factors. Past studies used self-reported training load, which mismatches wearables. Objective data on training's CAD impact was missing. An analysis published in the Circulation fills that gap.
Master@Heart Cohort Breakdown
Study drew from 222 males, median age 54 years (49-59 range). Groups: 77 lifelong athletes, 98 late-onset athletes, 47 controls. Training load came from 12 months of wearable data on duration and intensity (eTRIMP). Self-reports added for comparison. CCTA checked plaque, CAC>0, CAC>100. 
Objective Load Drives CAD Odds
eTRIMP quartiles showed differences: ≥1 plaque (p<0.001), CAC>0 (p=0.002), CAC>100 (p=0.012). High eTRIMP (Q4) had OR 5.85 (95% CI 2.33-14.71) for plaque, 5.03 (2.04-12.35) for CAC>0, 3.50 (1.22-10.00) for CAC>100 vs Q1. Continuous models confirmed eTRIMP and duration link to plaque and CAC>100 (p<0.05). Self-reported duration tied only to CAC>100 (p<0.05). MET-min/week from self-reports showed no CAD tie (p>0.05).
Rethink Athlete Heart Checks
Long hours plus intense eTRIMP boost subclinical CAD in athletes and active men. Intensity without volume spares risk. Use wearables for true TL.