Coronary Heart Disease in Marathon Runners

Abstract

Six highly trained marathon runners developed myocardial infarction. One of the two cases of clinically diagnosed myocardial infarction was fatal, and there were four cases of angiographically-proven infarction. Two athletes had significant arterial disease of two major coronary arteries, a third had stenosis of the anterior descending and the fourth of the right coronary artery. All these athletes had warning symptoms. Three of them completed marathon races despite symptoms, one athlete running more than 20 miles after the onset of exertional discomfort to complete the 56 mile Comrades Marathon. In spite of developing chest pain, another athlete who died had continued training for three weeks, including a 40 mile run. Two other athletes also continued to train with chest pain. We conclude that the marathon runners studied were not immune to coronary heart disease, nor to coronary atherosclerosis and that high levels of physical fitness did not guarantee the absence of significant cardiovascular disease. In addition, the relationship of exercise and myocardial infarction was complex because two athletes developed myocardial infarction during marathon running in the absence of complete coronary artery occlusion. We stress that marathon runners, like other sportsmen, should be warned of the serious significance of the development of exertional symptoms. Our conclusions do not reflect on the possible value of exercise in the prevention of coronary heart disease. Rather we refute exaggerated claims that marathon running provides complete immunity from coronary heart disease.

Normal Post-Race Antimyosin Myocardial Scintigraphy in Asymptomatic Marathon Runners with Elevated Serum Creatine Kinase MB Isoenzyme and Troponin T Levels

“…to the fatalities among participants in the 25th running of the New York City Marathon in 1994 [1], sudden cardiac death during sport remains disturbingly enigmatic [2], Recent epidemiologic studies demonstrate the triggering effect of vigorous physical exertion for acute myocardial infarction even among physically fit individuals [3,4], This corroborates descriptive studies linking running to sudden cardiac death [5] and marathon competition to fatal myocardial infarction [6], While atherosclerotic heart disease is the predominant underlying pathology in such cases [7], exercise-induced myocardial infarction may also occur in the presence of normal coronary arter ies [8], Diagnosis of acute myocardial infarction in marathon runners is complicated by elevation of creatine kinase MB isoenzyme in serum from exertional rhabdomyolysis of skeletal muscle biochemically altered by training [9], Neg ative post-race infarct-avid scintigraphy [10] and thallium-201 perfusion imaging [11] do not exclude silent myocardial cell necrosis in such runners as a contributing tissue source [12],…”

Historical Concepts of the Athlete???s Heart

“…This article (44) was one of several (31,32) that ultimately debunked what was called the "Bassler Hypothesis," named after Dr. Thomas Bassler, a California pathologist. The Bassler Hypothesis maintained that completing a marathon provided immunity against coronary artery disease events.…”

“…These letters had an air of authenticity because they often referenced earlier letters making the same claim (11). The Bassler Hypothesis disappeared after definitive rebuttals (32).…”

Grand Rounds--Hammersmith Hospital: Hazards of running a marathon

“…Sudden death during a marathon can be due to hypertrophic cardiomyopathy,8 especially in younger athletes, but is more often due to myocardial infarction consequent on coronary artery disease 9. Runners in the latter category are usually middle aged and may show evidence of severe atherosclerosis at postmortem examination 10.…”