People who exercise very hard a lot have way more clogged arteries than those who exercise less, but only if you measure their effort with devices, not just asking them.

High-volume, high-intensity endurance exercise increases coronary artery plaque burden without increasing all-cause or cardiovascular mortality risk in otherwise healthy individuals.

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.

Men who have trained for decades as elite endurance athletes, like cyclists or marathoners, tend to have more fatty deposits in their heart arteries than healthy men who exercise moderately—even when both groups are fit and have normal cholesterol and blood pressure.

Chronic high-volume endurance exercise is associated with the development of calcified coronary artery plaque, which is biomechanically more stable and less prone to rupture than non-calcified or mixed plaque.

The association between cumulative exercise volume and coronary plaque burden is significantly amplified when the volume includes a high proportion of high-intensity training sessions.