Alterations in the autonomic and haemodynamic response to prolonged high‐intensity endurance exercise in individuals with coronary artery calcification

Abstract Endurance exercise is associated with increased life duration and improved life quality. Paradoxically, high exercise intensity is also associated with increased coronary artery calcification (CAC) and a small but significant increased risk of adverse cardiac events during exercise. The mec...

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Main Authors: Jakob Svane, Tomasz Wiktorski, Trygve Eftestøl, Stein Ørn
Format: Article
Language:English
Published: Wiley 2025-03-01
Series:Experimental Physiology
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Online Access:https://doi.org/10.1113/EP092201
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author Jakob Svane
Tomasz Wiktorski
Trygve Eftestøl
Stein Ørn
author_facet Jakob Svane
Tomasz Wiktorski
Trygve Eftestøl
Stein Ørn
author_sort Jakob Svane
collection DOAJ
description Abstract Endurance exercise is associated with increased life duration and improved life quality. Paradoxically, high exercise intensity is also associated with increased coronary artery calcification (CAC) and a small but significant increased risk of adverse cardiac events during exercise. The mechanisms underlying the development of CAC during prolonged high‐intensity endurance exercise are unknown. This study aims to determine if there are differences in cardiovascular haemodynamic measures and heart rate variability (HRV) in individuals with (CAC+) and without CAC (CAC−). Hemodynamic measures from 56 healthy, middle‐aged (median [interquartile range] 51 [43–58] years) individuals (41 men/15 women) participating in a 91 km [251.2 [217.2‐271.6] min] leisure sport mountain bike race were included in this study. Twenty‐five participants (20 men/5 women) were classified as CAC+ based on coronary computed tomographic assessment. Haemodynamic measures and HRV were quantified at the top of the hardest hill (THH) during the last quarter of the race. At the top of THH, CAC+ individuals had significantly higher systolic blood pressure (SBP) (235 [225–245] mmHg vs. 220 [193–238] mmHg, P = 0.008), higher diastolic blood pressure (DBP) (105 [95–110] mmHg vs. 95 [85–110] mmHg, P = 0.006), higher pulse pressure (130 [125–140] mmHg vs. 123 [110–130] mmHg, P = 0.039), higher mean rate pressure product (33,882 [30,872–35,053] bpm × mmHg vs. 31,028 [27,392–33,047] bpm × mmHg, P = 0.028), and larger increase in DBP from baseline (20 [20–30] mmHg vs. 10 [0–20] mmHg, P = 0.001), compared with CAC− individuals. Further, CAC+ participants showed a significant reduction in the low‐frequency component of HRV (HRVLF) (6.3 [2.4–11.5] ms2 vs. 12.4 [6.8–20.2] ms2, P = 0.044). In multivariable analysis, HRVLF was an independent predictor of the presence of CAC even after adjusting for established risk factors of atherosclerosis: age, sex, body mass index, maximum heart rate, V̇O2max, smoking, resting SBP and resting DBP. CAC+ individuals had significant alterations in haemodynamic measures and HRVLF following prolonged high‐intensity endurance exercise compared with individuals without CAC. HRVLF was an independent predictor of CAC, suggesting an adverse autonomic response to high‐intensity endurance exercise in individuals with CAC.
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spelling doaj-art-fa862bb9bb1044af86ca451e91c061bc2025-08-20T03:16:34ZengWileyExperimental Physiology0958-06701469-445X2025-03-01110345446310.1113/EP092201Alterations in the autonomic and haemodynamic response to prolonged high‐intensity endurance exercise in individuals with coronary artery calcificationJakob Svane0Tomasz Wiktorski1Trygve Eftestøl2Stein Ørn3Department of Electrical Engineering and Computer Science University of Stavanger Stavanger NorwayDepartment of Electrical Engineering and Computer Science University of Stavanger Stavanger NorwayDepartment of Electrical Engineering and Computer Science University of Stavanger Stavanger NorwayDivision of Cardiology Stavanger University Hospital Stavanger NorwayAbstract Endurance exercise is associated with increased life duration and improved life quality. Paradoxically, high exercise intensity is also associated with increased coronary artery calcification (CAC) and a small but significant increased risk of adverse cardiac events during exercise. The mechanisms underlying the development of CAC during prolonged high‐intensity endurance exercise are unknown. This study aims to determine if there are differences in cardiovascular haemodynamic measures and heart rate variability (HRV) in individuals with (CAC+) and without CAC (CAC−). Hemodynamic measures from 56 healthy, middle‐aged (median [interquartile range] 51 [43–58] years) individuals (41 men/15 women) participating in a 91 km [251.2 [217.2‐271.6] min] leisure sport mountain bike race were included in this study. Twenty‐five participants (20 men/5 women) were classified as CAC+ based on coronary computed tomographic assessment. Haemodynamic measures and HRV were quantified at the top of the hardest hill (THH) during the last quarter of the race. At the top of THH, CAC+ individuals had significantly higher systolic blood pressure (SBP) (235 [225–245] mmHg vs. 220 [193–238] mmHg, P = 0.008), higher diastolic blood pressure (DBP) (105 [95–110] mmHg vs. 95 [85–110] mmHg, P = 0.006), higher pulse pressure (130 [125–140] mmHg vs. 123 [110–130] mmHg, P = 0.039), higher mean rate pressure product (33,882 [30,872–35,053] bpm × mmHg vs. 31,028 [27,392–33,047] bpm × mmHg, P = 0.028), and larger increase in DBP from baseline (20 [20–30] mmHg vs. 10 [0–20] mmHg, P = 0.001), compared with CAC− individuals. Further, CAC+ participants showed a significant reduction in the low‐frequency component of HRV (HRVLF) (6.3 [2.4–11.5] ms2 vs. 12.4 [6.8–20.2] ms2, P = 0.044). In multivariable analysis, HRVLF was an independent predictor of the presence of CAC even after adjusting for established risk factors of atherosclerosis: age, sex, body mass index, maximum heart rate, V̇O2max, smoking, resting SBP and resting DBP. CAC+ individuals had significant alterations in haemodynamic measures and HRVLF following prolonged high‐intensity endurance exercise compared with individuals without CAC. HRVLF was an independent predictor of CAC, suggesting an adverse autonomic response to high‐intensity endurance exercise in individuals with CAC.https://doi.org/10.1113/EP092201coronary artery calcificationexerciseheart rate variability
spellingShingle Jakob Svane
Tomasz Wiktorski
Trygve Eftestøl
Stein Ørn
Alterations in the autonomic and haemodynamic response to prolonged high‐intensity endurance exercise in individuals with coronary artery calcification
Experimental Physiology
coronary artery calcification
exercise
heart rate variability
title Alterations in the autonomic and haemodynamic response to prolonged high‐intensity endurance exercise in individuals with coronary artery calcification
title_full Alterations in the autonomic and haemodynamic response to prolonged high‐intensity endurance exercise in individuals with coronary artery calcification
title_fullStr Alterations in the autonomic and haemodynamic response to prolonged high‐intensity endurance exercise in individuals with coronary artery calcification
title_full_unstemmed Alterations in the autonomic and haemodynamic response to prolonged high‐intensity endurance exercise in individuals with coronary artery calcification
title_short Alterations in the autonomic and haemodynamic response to prolonged high‐intensity endurance exercise in individuals with coronary artery calcification
title_sort alterations in the autonomic and haemodynamic response to prolonged high intensity endurance exercise in individuals with coronary artery calcification
topic coronary artery calcification
exercise
heart rate variability
url https://doi.org/10.1113/EP092201
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AT tomaszwiktorski alterationsintheautonomicandhaemodynamicresponsetoprolongedhighintensityenduranceexerciseinindividualswithcoronaryarterycalcification
AT trygveeftestøl alterationsintheautonomicandhaemodynamicresponsetoprolongedhighintensityenduranceexerciseinindividualswithcoronaryarterycalcification
AT steinørn alterationsintheautonomicandhaemodynamicresponsetoprolongedhighintensityenduranceexerciseinindividualswithcoronaryarterycalcification