Even though endurance athletes have more plaque in their heart arteries, the dangerous, rupture-prone kind is actually rarer in them than in healthy non-athletes, which might explain why they rarely have heart attacks.

Even though endurance athletes have more fatty deposits in the main heart arteries—especially the soft, unstable kind—they don’t have the dangerous features that usually make plaques burst and cause heart attacks.

People who train hard and regularly for endurance sports are less likely to have dangerous, unstable plaque in their heart arteries that could suddenly cause a heart attack.

Even though athletes are super fit, their heart plaques aren’t more stable or ‘safer’ than those of healthy non-athletes—so being an elite athlete doesn’t make plaque less dangerous.

Even though elite athletes have more plaque in their hearts, the type of plaque they have is harder and less likely to rupture — which might be why they live longer than you’d expect.

The presence of increased coronary artery plaque in high-volume endurance athletes is not associated with a higher incidence of clinical cardiovascular events such as myocardial infarction or cardiac death.