Sudden Death in Marathon Runners

James, Jason; Merghani, Ahmed; Sharma, Sanjay

doi:10.1016/j.ccep.2013.01.003

Cited by 9 publications

(6 citation statements)

References 31 publications

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“…It has previously been shown that among individuals with subclinical CAD (CAC >100 Agatston units), a high degree of fitness reduces the risk of adverse cardiac events by 75%, 37 and it is possible that the higher coronary plaque burden in lifelong endurance athletes may be partly mitigated by the stable nature of their more calcified plaques and could explain the overall low risk of myocardial infarction in established marathon runners. 38 Although it is plausible that calcific plaques in masters athletes protect from acute myocardial infarction because of plaque rupture, the same stable calcified plaques may cause sufficient coronary stenosis and demand ischemia to produce myocardial scarring and fatal arrhythmias in some athletes. Consistent with this possibility is the observation of myocardial fibrosis compatible with a CAD pattern and nonsustained ventricular tachycardia in 3 of 8 (37.5%) male masters athletes with a luminal stenosis ≥50%.…”

Section: Differences In Plaque Composition Between Male Masters Athlementioning

confidence: 99%

Prevalence of Subclinical Coronary Artery Disease in Masters Endurance Athletes With a Low Atherosclerotic Risk Profile

et al. 2017

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BACKGROUND: Studies in middle-age and older (masters) athletes with atherosclerotic risk factors for coronary artery disease report higher coronary artery calcium (CAC) scores compared with sedentary individuals. Few studies have assessed the prevalence of coronary artery disease in masters athletes with a low atherosclerotic risk profile. METHODS:We assessed 152 masters athletes 54.4±8.5 years of age (70% male) and 92 controls of similar age, sex, and low Framingham 10-year coronary artery disease risk scores with an echocardiogram, exercise stress test, computerized tomographic coronary angiogram, and cardiovascular magnetic resonance imaging with late gadolinium enhancement and a 24-hour Holter. Athletes had participated in endurance exercise for an average of 31±12.6 years. The majority (77%) were runners, with a median of 13 marathon runs per athlete. RESULTS:Most athletes (60%) and controls (63%) had a normal CAC score. Male athletes had a higher prevalence of atherosclerotic plaques of any luminal irregularity (44.3% versus 22.2%; P=0.009) compared with sedentary males, and only male athletes showed a CAC ≥300 Agatston units (11.3%) and a luminal stenosis ≥50% (7.5%). Male athletes demonstrated predominantly calcific plaques (72.7%), whereas sedentary males showed predominantly mixed morphology plaques (61.5%). The number of years of training was the only independent variable associated with increased risk of CAC >70th percentile for age or luminal stenosis ≥50% in male athletes (odds ratio, 1.08; 95% confidence interval, 1.01-1.15; P=0.016); 15 (14%) male athletes but none of the controls revealed late gadolinium enhancement on cardiovascular magnetic resonance imaging. Of these athletes, 7 had a pattern consistent with previous myocardial infarction, including 3(42%) with a luminal stenosis ≥50% in the corresponding artery. CONCLUSIONS:Most lifelong masters endurance athletes with a low atherosclerotic risk profile have normal CAC scores. Male athletes are more likely to have a CAC score >300 Agatston units or coronary plaques compared with sedentary males with a similar risk profile. The significance of these observations is uncertain, but the predominantly calcific morphology of the plaques in athletes indicates potentially different pathophysiological mechanisms for plaque formation in athletic versus sedentary men. Coronary plaques are more abundant in athletes, whereas their stable nature could mitigate the risk of plaque rupture and acute myocardial infarction. Prevalence of Subclinical Coronary Artery Disease in Masters Endurance Athletes With a Low Atherosclerotic Risk Profile© 2017 American Heart Association, Inc. ORIGINAL RESEARCH ARTICLE R egular exercise confers a low risk profile for atherosclerosis and is associated with a 50% reduction in adverse events from coronary artery disease (CAD).1,2 The amount of physical activity required to achieve these benefits is 150 minutes of moderate exercise per week. [3][4][5][6] In contrast, some athletes engage in several hours of intensive training p...

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Section: Differences In Plaque Composition Between Male Masters Athlementioning

confidence: 99%

Prevalence of Subclinical Coronary Artery Disease in Masters Endurance Athletes With a Low Atherosclerotic Risk Profile

et al. 2017

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“…34 The prevalence of sudden cardiac death (SCD) varies according to methods of data collection but the most reliable data reveal a prevalence of 1 in 50 000 in young competitive athletes 35 and in middle aged marathoners. 36 Ninety per cent of victims are male. Although deaths in competitive athlete afford considerable media attention, over 90% of all exercise-related SCDs occur in recreational athletes.…”

Section: Sudden Cardiac Death In Sportmentioning

confidence: 99%

Exercise and the heart: the good, the bad, and the ugly

Sharma

Merghani

Mont

2015

European Heart Journal

301

205

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The benefits of exercise are irrefutable. Individuals engaging in regular exercise have a favourable cardiovascular risk profile for coronary artery disease and reduce their risk of myocardial infarction by 50%. Exercise promotes longevity of life, reduces the risk of some malignancies, retards the onset of dementia, and is as considered an antidepressant. Most of these benefits are attributable to moderate exercise, whereas athletes perform way beyond the recommended levels of physical activity and constantly push back the frontiers of human endurance. The cardiovascular adaptation for generating a large and sustained increase in cardiac output during prolonged exercise includes a 10-20% increase in cardiac dimensions. In rare instances, these physiological increases in cardiac size overlap with morphologically mild expressions of the primary cardiomyopathies and resolving the diagnostic dilemma can be challenging. Intense exercise may infrequently trigger arrhythmogenic sudden cardiac death in an athlete harbouring asymptomatic cardiac disease. In parallel with the extraordinary athletic milieu of physical performances previously considered unachievable, there is emerging data indicating that long-standing vigorous exercise may be associated with adverse electrical and structural remodelling in otherwise normal hearts. Finally, in the current era of celebrity athletes and lucrative sport contracts, several athletes have succumbed to using performance enhancing agents for success which are detrimental to cardiac health. This article discusses the issues abovementioned, which can be broadly classified as the good, bad, and ugly aspects of sports cardiology.

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“…So one of the important goals of modern sports medicine is to reduce the risk of SCD in athletes to "inevitable rarity". For individuals over 35 years, the undisputable reason of SCD is early onset of coronary arteries disease (CAD) (2,3,15). The incidence of SCD of younger (< 35 years old) athletes varies in different populations and is estimated at 0.5-4:100,000/year (2,4).…”

Section: Epidemiology Of Scdmentioning

confidence: 99%