Risk Stratification for Coronary Artery Disease in Marathon Runners

Risk Stratification for Coronary Artery Disease in Marathon Runners

Erbel Raimund, Heusch Gerd , Möhlenkamp Stefan
European Cardiology - Volume 4 - Issue I
Published: August 2008
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Table 1: American Heart Association Consensus Panel – Recommendations for Pre-participation Screening



Figure 1: Difference in Conventional Cardiovascular Risk Factors in Marathon Runners


Difference in conventional cardiovascular risk factors in marathon runners compared with age-matched controls from the Heinz Nixdorf Recall Study. The values indicated average risk factors in marathon runners. The lower risk factor burden results in a Framingham risk score that is only half of that seen in age-matched controls from the unselected general population. ‘Smoking’ indicates ‘ever smoked’. BMI = body mass index; LDL-C = low-density lipoprotein cholesterol; HDL-C = high-density lipoprotein cholesterol; FRS = Framingham risk score.




Risk Factor Burden in Marathon Runners
Regular physical activity has a beneficial impact on most modifiable CV risk factors.34 In normotensive subjects, average resting systolic and diastolic blood pressures are reduced by 3.4 and 2.4mmHg, respectively, with a much greater effect in hypertensive persons.34 High-density lipoprotein (HDL) cholesterol levels can be expected to increase by 3.0–4.6%, while triglyceride and LDL-cholesterol concentrations may decrease by 0.6–3.7% and 0.8–5.0%, respectively.34–36 Exercise programmes help to maintain smoking cessation37 and weight loss,38 and beneficially affect glucose metabolism in diabetics.39 In the Marathon Study cohort, all established risk factors were improved compared with age-matched controls (see Figure 1). In addition, runners had lower heart rates than controls (64.8±10 versus 76.4±11.8 beats per minute, respectively; p<0.0001) as well as lower high sensitivity C-reactive protein (hs-CRP) levels (0.1±0.2 versus 0.3±0.6mg/dl, respectively; p<0.0001) and leukocyte levels (5.3±1.2 versus 7.1±1.9nl, respectively; p<0.0001). The Framingham risk score in marathon runners (7.0±3.6% in 10 years) was even lower compared with women of a similar age from the general population (7.6±4.9% in 10 years).22,23 These findings suggest that longterm regular aerobic exercise may improve CV risk factor burden beyond previous observations from controlled prospective studies with follow-up periods of often not more than six to 12 months.

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