Relationship Between Exercise-Induced Cardiac Troponin Elevations and Occult Coronary Atherosclerosis in Middle-Aged Athletes

Janssen, SLJE; van Everdingen, WM; Saalmink, WBJ; Lamers, SK; Vroemen, WHM; Denessen, EJS; Berge, K; Bekers, O; Hopman, MTE; Brink, M; Habets, J; Aengevaeren, VL; Mingels, AMA; Nijveldt, R; Eijsvogels, TMH; TREAT study collaboration

doi:10.1016/j.jacc.2025.04.047

Coronary disease & ACS

Relationship Between Exercise-Induced Cardiac Troponin Elevations and Occult Coronary Atherosclerosis in Middle-Aged Athletes

J Am Coll CardiolPublished 24 Jun 2025Cross-sectional study

Main finding · Coronary atherosclerosisResultOdds ratio (adjusted) 1.55 95% CI 0.81–2.93

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Authors' conclusion

The prevalence and magnitude of coronary atherosclerosis did not differ between recreational athletes with high vs low postexercise cTn concentrations.

Study context

Population: Middle-aged recreational long-distance walkers, cyclists and runners (median age 56 years, 63% male)68 high vs 34 low responders had computed tomography (CT)
Participants: 1,011 walkers

Exposure: High vs low postexercise cardiac troponin (cTn) responders
High cTn respondersn = 68
Low respondersn = 34reference
Outcome: Prevalence and magnitude of coronary atherosclerosis on cardiac CT (CAD-RADS 2.0 score, CAC score)

Methodological detailsmatched for age, sex and sport type

Matched for age, sex and sport type

Main finding

Coronary atherosclerosis

Odds ratio (adjusted)

1.55

95% CI 0.81–2.93

By group

High cTn responders

CAD-RADS >0: 67.6%
CAC score, median: 9 AU [Q1-Q3: 0-111 AU]

Low responders

CAD-RADS >0: 50.0%
CAC score, median: 2 AU [Q1-Q3: 0-145 AU]

CAD-RADS >0

High cTn responders67.6%

Low responders50.0%

CAC score, median

High cTn responders9 AU [Q1-Q3: 0-111 AU]

Low responders2 AU [Q1-Q3: 0-145 AU]

High cTn respondersvs Low responders

OR (adjusted) 1.55 (95% CI 0.81–2.93)

As reported in the abstract

Observational data: associations, not effects.

Further findings

Outcome	High cTn responders	Low responders	← Lower odds with high cTn responders ←→ Higher odds with high cTn responders →	OR (adjusted) (CI)
CT-FFR ≤0.75Interval printed as Q1-Q3	11.8%	5.9%	0.512	1.03 (0.67–1.60)
			0.512Odds ratio (adjusted) (log scale)

High-sensitivity cardiac troponin T (hs-cTnT), hs-cTnI concentrations and CAD-RADS classifications

Weak associations: P < 0.05; R2: 4%-8%

Original publication

Relationship Between Exercise-Induced Cardiac Troponin Elevations and Occult Coronary Atherosclerosis in Middle-Aged Athletes. J Am Coll Cardiol. Published 24 June 2025. doi:10.1016/j.jacc.2025.04.047

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