Running: the risk of coronary events : Prevalence and prognostic relevance of coronary atherosclerosis in marathon runners.
Level 3 - non-randomized controlled study
Non-randomized matched controlled cohort study with prospective follow-up
PubMed 18426850 · doi:10.1093/eurheartj/ehn163
What was done
Coronary artery calcification (CAC), late gadolinium enhancement (LGE) on cardiac MRI, and Framingham risk score (FRS) were measured in 108 apparently healthy male marathon runners (aged ≥50 years, ≥5 marathons in the previous 3 years). Runners were compared with age-matched (8:1) and FRS-matched (2:1) controls from the Heinz Nixdorf Recall Study and followed for coronary events over 21.3 ± 2.8 months.
What was found
FRS was lower in marathon runners than age-matched controls (7 vs. 11%, P < 0.0001). Median CAC was similar between runners and age-matched controls (36 vs. 38, P = 0.36), but higher in runners than in FRS-matched controls (36 vs. 12, P = 0.02). CAC percentiles and number of marathons independently predicted LGE (prevalence 12%, P = 0.02 for both). Four runners (all with CAC ≥ 100) experienced coronary events during follow-up, with event-free survival inversely related to CAC burden (P = 0.018).
Why it matters
Standard risk calculations can underestimate coronary calcification in veteran male endurance runners, in whom CAC burden and marathon frequency are associated with subclinical myocardial damage and prospective coronary events.
Limits
The study included only older male runners (≥50 years), precluding generalization to women or younger athletes. Follow-up was short (~21 months) and the number of clinical events was small (4 events).
Cited by
- supports In the Möhlenkamp German marathon runner study, 50% of the runners were smokers and had started training later in life.