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BACKGROUND: Exercise increases cardiac troponin (cTn) concentrations with significant heterogeneity across individuals. OBJECTIVES: This study compared the prevalence and magnitude of coronary atherosclerosis in middle-aged recreational athletes with high vs low postexercise cTn concentrations. METHODS: Pre- and postexercise concentrations of high-sensitivity cardiac troponin T (hs-cTnT) and hs-cTnI were assessed among 1,011 long-distance walkers, cyclists, and runners (median age 56 years [Q1-Q3: 49-62 years], 63% male). Subsequently, 68 high cTn responders (hs-cTnT: 35.4 ng/L [Q1-Q3: 20.2-54.0 ng/L]; hs-cTnI: 47.4 ng/L [Q1-Q3: 22.5-97.4 ng/L]) and 34 low responders (hs-cTnT: 8.5 ng/L [Q1-Q3: 5.4-13.3 ng/L]; hs-cTnI: 2.5 ng/L [Q1-Q3: 1.5-5.8 ng/L]), matched for age, sex, and sport type, underwent a cardiac computed tomography (CT) scan to determine the presence and characteristics of coronary atherosclerosis (Coronary Artery Disease-Reporting and Data System [CAD-RADS] 2.0 score and coronary artery calcium scores). CT-derived fractional flow reserve (CT-FFR) analyses assessed the hemodynamic relevance of stenoses ≥25% to 90%. RESULTS: The prevalence (CAD-RADS >0 in 67.6% vs 50.0%; OR: 1.55 [95% CI: 0.81-2.93]) and magnitude (coronary artery calcium score: 9 AU [Q1-Q3: 0-111 AU] vs 2 AU [Q1-Q3: 0-145 AU]; P = 0.58) of coronary atherosclerosis did not differ between high and low cTn responders. CT-FFR outcomes (FFR ≤0.75: 11.8% vs 5.9%; OR: 1.03 [Q1-Q3: 0.67-1.60]) also revealed no differences between high and low cTn responders. Nevertheless, weak associations (P < 0.05; R: 4%-8%) were found between hs-cTnT, hs-cTnI concentrations, and CAD-RADS classifications. CONCLUSIONS: The prevalence and magnitude of coronary atherosclerosis did not differ between recreational athletes with high vs low postexercise cTn concentrations. This suggests that most of the interindividual variation in exercise-induced cTn elevations is not attributable to occult coronary atherosclerosis.