Running: the risk of coronary events : Prevalence and prognostic relevance of coronary atherosclerosis in marathon runners.
OBJECTIVE
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.


RESULTS
In 108 apparently healthy male marathon runners aged >or=50 years, with >or=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 >or= 100 experienced coronary events. Event-free survival was inversely related to CAC burden (P = 0.018).


CONCLUSIONS
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.
Möhlenkamp
Stefan
S
Clinic of Cardiology, West-German Heart Center Essen, University Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany. stefan.moehlenkamp@uk-essen.de
Lehmann
Nils
N
Breuckmann
Frank
F
Bröcker-Preuss
Martina
M
Nassenstein
Kai
K
Halle
Martin
M
Budde
Thomas
T
Mann
Klaus
K
Barkhausen
Jörg
J
Heusch
Gerd
G
Jöckel
Karl-Heinz
KH
Erbel
Raimund
R
D000368:Aged; D002114:Calcinosis / Q000175:diagnosis / Q000503:physiopathology*; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000503:physiopathology*; D016757:Death, Sudden, Cardiac / Q000517:prevention & control; D003925:Diabetic Angiopathies / Q000150:complications; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010807:Physical Endurance; D011237:Predictive Value of Tests; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D012420:Running / Q000502:physiology*; D014057:Tomography, X-Ray Computed