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European Heart Journal Advance Access originally published online on April 21, 2008
European Heart Journal 2008 29(15):1903-1910; doi:10.1093/eurheartj/ehn163
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Running: the risk of coronary events {dagger}

Prevalence and prognostic relevance of coronary atherosclerosis in marathon runners

Stefan Möhlenkamp1,*, Nils Lehmann2, Frank Breuckmann1, Martina Bröcker-Preuss3, Kai Nassenstein4, Martin Halle5, Thomas Budde6, Klaus Mann3, Jörg Barkhausen4, Gerd Heusch7, Karl-Heinz Jöckel2, Raimund Erbel1 on behalf of the Marathon Study Investigators and the Heinz Nixdorf Recall Study Investigators

1 Clinic of Cardiology, West-German Heart Center Essen, University Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany
2 Institute of Medical Informatics, Biometry and Epidemiology, University Duisburg-Essen, Essen, Germany
3 Institute of Clinical Chemistry and Laboratory Medicine, University Duisburg-Essen, Essen, Germany
4 Department of Diagnostic and Interventional Radiology and Neuroradiology, University Duisburg-Essen, Essen, Germany
5 Clinic of Preventive and Rehabilitative Sports Medicine, Technical University Munich, Essen, Germany
6 Clinic of Internal Medicine and Cardiology, Alfried Krupp Krankenhaus, Essen, Germany
7 Institute of Pathophysiology, University Duisburg-Essen, Essen, Germany

Received 27 January 2008; revised 20 March 2008; accepted 27 March 2008; online publish-ahead-of-print 21 April 2008.

* Corresponding author. Tel: +49 201 723 4803, Fax: +49 201 723 5403, Email: stefan.moehlenkamp{at}uk-essen.de

See page 1800 for the editorial comment on this article (doi:10.1093/eurheartj/ehn273)

Aims: To quantify the prevalence of coronary artery calcification (CAC) in relation to cardiovascular risk factors in marathon runners, and to study its role for myocardial damage and coronary events.

Methods and results: In 108 apparently healthy male marathon runners aged ≥50 years, with ≥5 marathon competitions during the previous three years, the running history, Framingham risk score (FRS), CAC, and presence of myocardial late gadolinium enhancement (LGE) were measured. Control groups were matched by age (8:1) and FRS (2:1) from the Heinz Nixdorf Recall Study. The FRS in marathon runners was lower than in age-matched controls (7 vs. 11%, P < 0.0001). However, the CAC distribution was similar in marathon runners and age-matched controls (median CAC: 36 vs. 38, P = 0.36) and higher in marathon runners than in FRS-matched controls (median CAC: 36 vs. 12, P = 0.02). CAC percentile values and number of marathons independently predicted the presence of LGE (prevalence = 12%) (P = 0.02 for both). During follow-up after 21.3 ± 2.8 months, four runners with CAC ≥ 100 experienced coronary events. Event-free survival was inversely related to CAC burden (P = 0.018).

Conclusion: Conventional cardiovascular risk stratification underestimates the CAC burden in presumably healthy marathon runners. As CAC burden and frequent marathon running seem to correlate with subclinical myocardial damage, an increased awareness of a potentially higher than anticipated coronary risk is warranted.

Key Words: Marathon running • Cardiovascular risk stratification • Coronary artery calcium • Late gadolinium enhancement

{dagger} The opinions expressed in this article are not necessarily those of the Editors of the European Heart Journal or of the European Society of Cardiology.


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Related articles in EHJ:

The risk of marathon runners–live it up, run fast, die young?
Axel Schmermund, Thomas Voigtländer, and Bernd Nowak
EHJ 2008 29: 1800-1802. [Extract] [Full Text]  



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