New meta-analysis on CAC and athletes - higher scores, not higher risk plaques

TLDR; "Our systematic review and meta-analysis shows that extreme endurance athletes have a higher prevalence of coronary atherosclerosis compared to those who do not engage in such activities, meaning that the former group has a higher risk of having at least one coronary plaque compared to the latter group. However, this increased prevalence of coronary atherosclerosis does not come with a higher presence of high-risk plaques. Additionally, our research shows that endurance athletes do not have a higher prevalence of obstructive plaques compared to the controls."

An interesting finding - even though the higher CAC isn't show to lead to worse outcomes among athletes, the authors are recommending CCTA vs simple CAC scoring for athletes: "First, although some studies have shown that athletes have higher CAC levels, there is no evidence that higher CAC levels correlate with worse outcomes. Second, given that endurance athletes have an increased risk of developing plaques, even in the absence of high-risk features, this population should undergo CCTA with plaque analysis rather than just a simple CAC score." (ital added)

https://www.sciencedirect.com/science/article/pii/S0167527325002153?via%3Dihub