Ultrasound Assessment of Arterial Medial Calcification in Endurance Athletes: A Prevalence Study (EMASE)

Medial arterial calcification (MAC) is an under-recognized vascular condition that remains poorly characterized from an epidemiological perspective. In the general population, its estimated prevalence is approximately 2.5%, mainly based on ankle-brachial index measurements. In contrast, prevalence exceeds 10% in high-risk populations such as patients with diabetes, chronic kidney disease, or established cardiovascular disease, with wide variability depending on the diagnostic method used.

In these populations, MAC is associated with adverse clinical outcomes, including critical limb ischemia, major amputation, and increased cardiovascular mortality, sometimes exceeding the prognostic impact of atherosclerosis. However, data on MAC in healthy individuals are currently lacking, and its clinical significance in this population remains unknown.

Endurance athletes represent a unique population exposed to prolonged and intense hemodynamic stress. Previous studies have reported increased coronary artery calcification in athletes with very high levels of physical activity, and differences according to sporting discipline. Incidental findings of MAC have also been observed in endurance athletes, raising the question of a potential association with training volume and vascular adaptations to long-term exercise.

The objective of this study is to assess the prevalence of medial arterial calcification in endurance athletes using ultrasound imaging, and to explore its relationship with training characteristics and cardiovascular risk markers.

Study Overview

• Status: Not yet recruiting
• Conditions: Calcifications, Vascular

• Study Type: Observational
• Enrollment (Estimated): 60

Contacts and Locations

• Study Contact: Name: Marwa Melkemi, Resident; Phone Number: +33 +33606471880; Email: melkmarwa@gmail.com
• Study Contact Backup: Name: Christophe Seinturier, Doctor; Phone Number: +33 +33645270690; Email: CSeinturier@chu-grenoble.fr

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

• Sampling Method: Non-Probability Sample

Study Population

Healthy endurance athletes volunteering for the study, engaging in more than 5 hours of high-intensity endurance exercise per week for at least the past 10 years.

Description

Inclusion Criteria:

• Healthy volunteer attending a sports medicine consultation for the performance of an exercise stress test*.
• Male or female subject.
• Age between 18 and 70 years, inclusive.
• High-level endurance athlete, with regular practice of endurance sports (trail running, road running, cycling, swimming, cross-country skiing, biathlon), with a MET-min/week > 2000, corresponding to more than 5 hours of vigorous physical activity per week, for more than 10 years.
• Affiliated with a social security system.
• No objection to participation in the study. * Undergoing a lower limb arterial ultrasound examination as part of routine clinical care.

Exclusion Criteria:

• Participants with type 1 or type 2 diabetes mellitus.
• Participants with chronic kidney disease, defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m².
• Resting arterial hypertension.
• Established cardiovascular disease (coronary artery disease, stroke, or peripheral arterial disease).
• Protected or vulnerable populations as defined by French Public Health Code articles L1121-5 to L1121-8, including:

pregnant or breastfeeding women, women in labor, individuals deprived of liberty by judicial or administrative decision, individuals receiving psychiatric care under articles L.3212-1 and L.3213-1, individuals admitted to healthcare or social institutions for purposes other than research, minors, individuals under legal protection, or individuals unable to provide informed consent.

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort

Healthy endurance athletes; Healthy volunteer attending a sports medicine consultation for the performance of an exercise stress test*. Male or female subject. Age between 18 and 70 years, inclusive. High-level endurance athlete, with regular practice of endurance sports (trail running, road running, cycling, swimming, cross-country skiing, biathlon), with a MET-min/week > 2000, corresponding to more than 5 hours of vigorous physical activity per week, for more than 10 years. Affiliated with a social security system. No objection to participation in the study. * Undergoing a lower limb arterial ultrasound examination as part of routine clinical care.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Presence or absence of medial arterial calcification detected by ultrasound in the lower limb arteries	Qualitative variable: number of subjects with medial arterial calcification. Measurement method: lower limb arterial duplex ultrasound (common and superficial femoral arteries, popliteal arteries, anterior tibial arteries, posterior tibial arteries), using a severity score ranging from 0 to 4 per side, i.e. 0 to 8 in total (0: completely normal vessel; 1: calcifications extending over < 1 cm; 2: calcifications over 1-2 cm; 3: calcifications over 2-3 cm; 4: calcifications over > 3 cm). A score of 0 indicates absence of medial arterial calcification, whereas a score of ≥ 1 indicates presence of medial arterial calcification.	At enrollment (single assessment on the day of inclusion)

Collaborators and Investigators

• Sponsor: University Hospital, Grenoble
• Investigators: Principal Investigator: Stéphane Doutreleau, Doctor, University Hospital, Grenoble; Study Director: Christophe Seinturier, Doctor, University Hospital, Grenoble

Study record dates

Study Major Dates

• Study Start (Estimated): February 1, 2026
• Primary Completion (Estimated): July 1, 2026
• Study Completion (Estimated): October 1, 2026

Study Registration Dates

• First Submitted: February 11, 2026
• First Submitted That Met QC Criteria: February 11, 2026
• First Posted (Actual): February 18, 2026

Study Record Updates

• Last Update Posted (Actual): February 18, 2026
• Last Update Submitted That Met QC Criteria: February 11, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Keywords: endurance athletes; medial arterial calcification
• Additional Relevant MeSH Terms: Metabolic Diseases; Calcium Metabolism Disorders; Calcinosis; Nutritional and Metabolic Diseases; Vascular Calcification
• Other Study ID Numbers: 38RC25.0430 - EMASE

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No