The unexpected relationships between both high dose statins and high level endurance exercise and coronary calcification

 The jury  has been back for a quite a while. Statins decrease the risk of coronary artery events. The curvilinear relationship between exercise and coronary artery events is also apparently beyond debate.

So one would not predict that both statins and exercise could be too much of a good thing in regard to coronary artery disease. Remember coronary calcification is, by defintion,coronary artery disease. 

There are ample data demonstrating that long time and high dose statin use  may increase the development of coronary calcification.In addition,there are reports of increased coronary calcification in long time marathon runners and endurance athletes. 

So,how does this work? Exercise at least  up to some level (that  level has yet to be defined) decreases CAD risk but at some level increases coronary artery calcification which is a marker of CAD. Is the calcification different in endurance athletes? There is evidence that in endurance athletes who have coronary calcification that there are more of the dense variety and less of the mixed type which is thought to be more likely to thrombosis.