Post-exercise cTn levels and coronary atherosclerosis in recreational athletes

ESC Preventive Cardiology 2025 – In an analysis of TREAT, there were no differences in the prevalence and magnitude of coronary atherosclerosis between recreational athletes with high versus low post-exercise cTn concentrations.

This summary is based on the presentation of Thijs Eijsvogels, PhD (Nijmegen, The Netherlands) at the ESC Preventive Cardiology 2025 - Exercise-induced cardiac troponin elevations and occult coronary atherosclerosis.

Introduction and methods

Exercise increases the concentration of cardiac troponins (cTn) in athletes, but there is great heterogeneity in the response among individuals. Previous work demonstrated that increases in post-exercise cTn concentrations above the 99th percentile level are associated with MACE. Coronary atherosclerosis is prevalent in recreational athletes and is a major cause of cardiac arrest in long-distance runners. This analysis of the TREAT study compared the prevalence and magnitude of coronary atherosclerosis in middle-aged recreational athletes with high versus low post-exercise cTn concentrations.

The current analysis of the prospective TREAT (cardiac TRoponin concentrations following Exercise and the Association with cardiovascular ouTcomes) study included 1011 recreational athletes ≥40 to <70 years old (mean age 56 years; 63% males) who were engaging in long-distance walking (≥30 km), cycling (≥100 km) or running (≥15 km). hs-cTnT and hs-cTnI concentrations were determined in blood samples pre- and post-race. Depending on the cTn concentrations, participants were stratified in a high cTn responder group (6.7%) and a low cTn responder group (3.3%). This subset of participants (n=102) was eligible for a cardiac CT scan to determine CAC score and plaque type and perform stenosis assessment.

Main results

• In the analytical cohort, there was an increase in hs-cTnT and hs-cTnI post-exercise.
• There was no difference in the prevalence of CACS>0 between high versus low cTn responders (64.7% vs. 50.0%; P=0.24).
• Compared with low cTn responders, there were no differences in the absolute CACS (P=0.58), distribution of CAD-RADS classification (P=0.38), and plaque type (all P>0.05) in high cTn responders.

Conclusion

In this analysis of TREAT, there was no difference in the prevalence and magnitude of coronary atherosclerosis between recreational athletes with low versus high post-exercise cTn concentrations.

- Our reporting is based on the information provided at the ESC Preventive Cardiology 2025 -