Coronary atherosclerosis and cardiovascular risk in masters male marathon runners: Rationale and design of the "marathon study"

Herz

Volumn 31, Issue 6, 2006, Pages 575-585

  Möhlenkamp, Stefan ^a   Schmermund, Axel ^b   Kröger, Knut ^a   Kerkhoff, Gert ^c   Bröcker Preuss, Martina ^a   Adams, Volker ^d   Hensel, Martin ^a   Kiefer, David ^a   Lehmann, Nils ^a   Moebus, Susanne ^a   Leineweber, Kirsten ^a   Elsenbruch, Sigrid ^a   Barkhausen, Jörg ^a   Halle, Martin ^e   Hambrecht, Rainer ^f   Siegrist, Johannes ^g   Mann, Klaus ^a   Budde, Thomas ^c   Jöckel, Karl Heinz ^a   Erbel, Raimund ^a  

^a UNIVERSITY HOSPITAL ESSEN   (Germany)

^b CARDIOANGIOLOGISCHES CENTRUM BETHANIEN   (Germany)

^c ALFRIED KRUPP KRANKENHAUS   (Germany)

^d UNIVERSITY OF LEIPZIG   (Germany)

^e TECHNICAL UNIVERSITY OF MUNICH   (Germany)

^f Klinikum Links der Weser   (Germany)

^g HEINRICH HEINE UNIVERSITY   (Germany)

Author keywords

Atherosclerosis ; Cardiovascular screening; Coronary artery disease; Electron beam CT; Marathon; Risk factors

Indexed keywords

BIOCHEMICAL MARKER; TROPONIN;

ANGINA PECTORIS; AORTA ATHEROSCLEROSIS; ARTICLE; ATHLETE; BLOOD EXAMINATION; CARDIOVASCULAR RISK; CAROTID ARTERY; CLINICAL CHEMISTRY; CORONARY ARTERY ATHEROSCLEROSIS; CORONARY ARTERY DISEASE; DEATH CERTIFICATE; DIABETES MELLITUS; DIAGNOSTIC IMAGING; DISEASE MARKER; ECHOCARDIOGRAPHY; ELECTROCARDIOGRAPHY; ELECTRON BEAM TOMOGRAPHY; ENDURANCE; EXERCISE; EXERCISE TEST; FEMORAL ARTERY; FLUORESCENCE ACTIVATED CELL SORTING; FOLLOW UP; HEART FUNCTION; HEART MUSCLE; HEART RATE; HORMONE BLOOD LEVEL; HUMAN; LABORATORY TEST; LIFESTYLE; MARATHON RUNNER; MEDICAL RECORD; NUCLEAR MAGNETIC RESONANCE IMAGING; PREDICTION; PSYCHOSOCIAL DISORDER; QUESTIONNAIRE; RISK ASSESSMENT; RISK FACTOR; SOCIOECONOMICS; STEM CELL; ULTRASOUND;

ADULT; AGE FACTORS; ALGORITHMS; ATHEROSCLEROSIS; COHORT STUDIES; CORONARY ARTERIOSCLEROSIS; CORONARY ARTERY DISEASE; ELECTROCARDIOGRAPHY; EXERCISE TEST; FOLLOW-UP STUDIES; HUMANS; LIFE STYLE; MALE; MIDDLE AGED; PREDICTIVE VALUE OF TESTS; PREVALENCE; QUESTIONNAIRES; RISK ASSESSMENT; RISK FACTORS; RUNNING; TIME FACTORS; TOMOGRAPHY, X-RAY COMPUTED;

EID: 33750064827     PISSN: 03409937     EISSN: None     Source Type: Journal    
DOI: 10.1007/s00059-006-2879-6     Document Type: Article

References (97)

1. Adams V, Lenk K, Linke A, et al. Increase of circulating endothelial progenitor cells in patients with coronary artery disease after exercise-induced ischemia. Arterioscler Thromb Vasc Biol 2004;24:684-90.
2. Adams V, Linke A, Krankel N, et al. Impact of regular physical acitivity on the NAD(P)H oxidase and angiotensin receptor system in patients with coronary artery disease. Circulation 2005;111:555-62.
3. Albert CM, Mittleman MA, Chae CU, et al. Triggering of sudden death from cardiac causes by vigorous exertion. N Engl J Med 2000;343:1355-61.
4. Arad Y, Goodman KJ, Roth M, et al. Coronary calcification, coronary disease risk factors, CRP, and atherosclerotic cardiovascular disease events. J Am Coll Cardiol 2005;46:158-65.
5. Assmann G, Cullen P, Schulte H. Simple scoring scheme for calculating the risk of acute coronary events based on the 10-year follow-up of the Prospective Cardiovascular Münster (PROCAM) study. Circulation 2002;105:310-5.
6. Bartsch P. Platelet activation with exercise and risk of cardiac events. Lancet 1999;354:1747-8.
7. Blair SN, Kampert JB, Kohl HW 3rd, et al. Influences of cardiorespiratory fitness and other precursors on cardiovascular disease and all-cause mortality in men and women. JAMA 1996;276:205-10.
8. Bots ML, Hoes AW, Koudstaal PJ, et al. Common carotid artery IMT and risk of stroke and myocardial infarction: the Rotterdam study. Circulation 1997;96:1432-7.
9. Budoff M. Computed tomography. In: Budoff M, Shinbane J, eds. Cardiac CT imaging. Diagnosis of cardiovascular disease. London: Springer, 2006:13-5.
10. Burke AP, Farb A, Malcom GT, et al. Plaque rupture and sudden death related to exertion in men with coronary artery disease. JAMA 1999;281:921-6.
11. Chambless LE, Folsom AR, Clegg LX, et al. Carotid wall thickness is predictive of incident clinical stroke: the Atherosclerosis Risk In Communities (ARIC) study. Am J Epidemiol 2000;151:478-87.
12. Chambless LE, Heiss G, Folsom AR, et al. Association of coronary heart disease incidence with carotid arterial wall thickness and major risk factors: the Atherosclerosis Risk in Communities (ARIC) study, 1987-1993. Am J Epidemiol 1997;146:483-94.
13. Curtis BM, O'Keefe JH. Autonomic tone as cardiovascular risk factor: the dangers of fight or flight. Mayo Clin Proc 2002;77:45-5.
14. Danese C, Vestri AR, D'Alfonso V, et al. Do hypertension and diabetes mellitus influence the site of atherosclerotic plaques? Clin Ther 2006;157:9-13.
15. Davies MJ. A macro and micro view of coronary vascular insult in ischemic heart disease. Circulation 1990;82:1138-46.
16. Douglas PS, O'Toole ML, Woolard J. Regional wall motion abnormalities after prolonged exercise. Circulation 1987;76:1206-13.
17. Erbel R, Budde T, Kerkhoff G, et al. Understanding the pathophysiology of the arterial wall: which method should we choose? EBCT. Eur Heart J 2002;4:Suppl F:F47-53.
18. European guidelines on cardiovascular disease prevention in clinical practice. Third Joint Task Force of European and Other Societies on Cardiovascular Disease Prevention in Clinical Practice. Eur Heart J 2003;24:1601-10.
19. Fowler-Brown A, Pignone M, Pletcher M, et al., U.S. Preventive Task Force. Exercise tolerance testing to screen for coronary heart disease: a systematic review for the technical support for the U.S. Preventive Services Task Force. Ann Intern Med 2004;140:W9-24.
20. Furberg CD, Adams HP, Applegate WB, et al. Effect of lovastatin on early carotid atherosclerosis and cardiovascular events. Circulation 1994;90:1679-87.
21. George K, Whyte G, Stephenson C, et al. Postexercise left ventricular function and cTNT in recreational marathon runners. Med Sci Sports Exerc 2004;36:1709-15.
22. Gibbons RJ, Balady GJ, Bricker JT, et al.,ACC/AHA Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines). ACC/AHA 2002 guideline update for exercise testing: summary article: a report of the ACC/AHA Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines). Circulation 2002;106:1883-92.
23. Giri S, Thompson PD, Kiernan FJ, et al. Clinial and angiographic characteristics of exertion-related acute myocardial infarction. JAMA 1999;282:1731-6.
24. Greenland P, Abrams J, Aurigemma GP, et al. Prevention Conference V. Beyond secondary prevention: identifying the high-risk patient for primary prevention. Noninvasive tests of atherosclerotic burden. Writing Group III. Circulation 2000;101:e16-22.
25. Greenland P, Smith SC Jr, Grundy SM. Improving coronary heart disease risk assessment in asymptomatic people: role of traditional risk factors and non-invasive cardiovascular tests. Circulation 2001;104:1863-7.
26. Held C, Hjemdahl P, Eriksson V, et al. Prognostic implications of intima-media thickness and plaques in the carotid and femoral arteries in patients with stable angina pectoris. Eur Heart J 2001;22:62-72.
27. Herrmann M, Scharhag J, Miclea M, et al. Post-race kinetics of cTnT and cTnI and NT-pro-BNP in marathon runners. Clin Chem 2003;49:831-4.
28. Hodis HN, Mack WJ, LaBree L, et al. The role of carotid arterial IMT in predicting clinical coronary events. Ann Intern Med 1998;128:262-9.
29. Hottenroth K, Hoos O, Esperer HD. Herzfrequenzvariabilität und Sport-aktueller Stand. Herz 2006;31:544-52.
30. Joint National Committee. The 7th report of the Joint National Committee (JNC) on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension 2003;42:1206-52.
31. Kean AJ, McCloskey VR, Seghatol FF, et al. Preservation of ventricular function in amateur athletes after completion of a marathon. J Am Soc Echocardiogr 2006;19:202-5.
32. Ketelhut RG, Ketelhut K, Messerli FH, et al. Fitness in the fit: does physical conditioning affect cardiovascular risk factors in middle-aged marathon runners? Eur Heart J 1996;17:199-203.
33. Kojda G, Hambrecht R. Molecular mechanisms of vascular adaptations to exercise. Physical activity as an effective antioxidant therapy? Cardiovasc Res 2005;67:187-97.
34. Kolodgie FD, Narula J, Burke AP, et al. Localization of apoptotic macrophages at the site of plaque rupture in sudden coronary death. Am J Pathol 2000;157:1259-68.
35. Kraemer WJ, Ratamess NA. Endocrine responses and adaptations to strength and power training. In: Komi PV, ed. Strength and power in sports, 2nd edn. Maiden: Blackwell Science, 2003:361-86.
36. Kratz A, Lewandrowski KB, Siegel AJ, et al. Effect of marathon running on hematologic and biochemical laboratory parameters, including cardiac markers. Am J Clin Pathol 2002;118:856-63.
37. Kroger K, Stang A, Kondratieva J, et al., Heinz Nixdorf Recall Study Group. Prevalence of peripheral arterial disease - results of the Heinz Nixdorf Recall Study. Eur J Epidemiol 2006;121:279-85.
38. LaMonte MJ, Fitzgerald SJ, Church TS, et al. Coronary artery calcium score and coronary heart disease events in a large cohort of asymptomatic men and women. Am J Epidemiol 2005;162:1-9.
39. Lauer M, Froelicher ES, Williams M, et al. Exercise testing in asymptomatic adults. A statement for professionals From the AHA Council on Clinical Cardiology, Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention. Circulation 2005;112:771-6.
40. Laufs U, Werner N, Link A, et al. Physical training increases endothelial progenitor cells, inhibits neointima formation, and enhances angiogenesis. Circulation 2004;109:220-6.
41. Legaz Arrese A, Serrano Ostariz E, Gonzales Carretero M, et al. Echocardiography to measure fitness of elite runners. J Am Soc Echocardiogr 2005;18:419-26.
42. Löllgen H. Herzfrequenzvariabilität. Dtsch Ärztebl 1999;96:A2029-32.
43. Maron BJ, Araújo CGS, Thompson PD, et al. Recommendations for preparticipation screening and the assessment of cardiovascular disease in masters athletes. An advisory for health care professionals from the working groups of the World Heart Federation, the International Federation of Sports Medicine, and the AHA Committee on Exercise, Cardiac Rehabilitation and Prevention.Circulation 2001;103:327-34.
44. Maron BJ, Douglas PS, Graham TP, et al. Task Force 1: Preparticipation screening and diagnosis of cardiovascular disease in athletes. J Am Coll Cardiol 2005;45:1322-6.
45. Maron BJ, Gohman TE, Aeppli D. Prevalence of sudden cardiac death during competitive sports activities in Minnesota high school athletes. J Am Coll Cardiol 1998;32:1881-4.
46. Maron BJ, Poliac LC, Roberts WO. Risk for sudden cardiac death associated with marathon running. J Am Coll Cardiol 1996;28:428-31.
47. Mittleman MA, Maclure M, Tofler GH, et al. Triggering of acute myocardial infarction by heavy physical exertion: protection against triggering by regular exertion. N Engl J Med 1993;329:1677-83.
48. Möhlenkamp S, Bauer M, Moebus S, et al. Koronarkalkquantifizierung und Intima-Media-Dickenmessung liefern unabhängige Information über die Ausprägung der subklinischen Arteriosklerose bei Männern - Ergebnisse aus der Heinz Nixdorf Recall Studie. Clin Res Cardiol 2006;95:Suppl 5:P1331 (http://ft2006.dgk.org/programm).
49. Möhlenkamp S, Roggenbuck LJ, Schmermund A, et al., for the Heinz Nixdorf Recall Study Investigators. Heart rate recovery after bicycle stress testing is delayed in subjects with elevated coronary atherosclerotic plaque burden in the general population. Circulation 2004;110:111-562.
50. Möhlenkamp S, Schmermund A, Kerkhoff G, et al. Prognostischer Nutzen der nicht-invasiv bestimmten koronaren Plaquelast bei Patienten mit Risikofaktoren. Z Kardiol 2003;92:351-61.
51. Möhlenkamp S, Schmermund A, Lehmann N, et al. The resting-ECG predicts the extent of subclincial coronary atherosclerosis independent of standard risk factors in a general population without CAD. Eur Heart J 2005;Suppl:A-3931.
52. Morganroth D, Barry J, Maron D, et al. Comparative left ventricular dimensions in trained athletes. Ann Intern Med 1975;82:521-4.
53. Naghavi M, Falk E, Hecht HS, et al. From vulnerable plaque to vulnerable patient - part III: Executive summary of the Screening for Heart Attack Prevention and Education (SHAPE)Task Force report. Am J Cardiol 2006;98:2H-15H.
54. National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (ATP III). 3rd report. Circulation 2002;106:3143-421.
55. Neilan TG, Yourger DM, Douglas PS, et al. Persistent and reversible cardiac dysfunction among amateur marathon runners. Eur Heart J 2006;127:1079-84.
56. O'Leary DH, Polak JF, Kronmal RA, et al. Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. N Engl J Med 1999;340:14-22.
57. Paterick TE, Paterick TJ, Fletcher GF, et al. Medical and legal issues in the cardiovascular evaluation of competitive athletes. JAMA 2005;294:3011-8.
58. Pedersen BK, Steensberg A, Fischer C, et al. Exercise and cytokines with particular focus on muscle-derived IL-6. Exerc Immunol Rev 2001;7:18-31.
59. Pellica A, Barry J, Maron D, et al. Th upper limit of physiologic cardiac hypertrophy in highly trained elite athletes. N Engl J Med 1991;324:295-301.
60. Pellica A, Culasso F, Di Paolo FM, et al. Physiologic left ventricular dilatation in elite athletes. Ann Intern Med 1999;130:23-31.
61. Pletcher MJ, Tice JA, Pignone M, et al. Using the CAC score to predict coronary heart disease events: a systematic review and meta-analysis. Arch Intern Med 2004;164:1285-92.
62. Ridker PM, Rifai N, Rose L, et al. Comparison of CRP and LDL-cholesterol levels in the prediction of first cardiovascular events. N Engl J Med 2002;347:1557-65.
63. Roberts WO, Maron BJ. Evidence for decreasing occurrence of sudden cardiac death associated with the marathon. J Am Coll Cardiol 2005;46:1374-5.
64. Ross R. Atherosclerosis - an inflammatory disease. N Engl J Med 1999;340:115-26.
65. Running USA Road Running Information Center (RRIC). Trend & demographics 2006. RRIC, 2006 (http://www.runningusa.org/cgi/mar_repts.pl).
66. Sandri M, Adams V, Gielen S, et al. Effects of exercise and ischemia on mobilization and functional activation of blood-derived progenitor cells in patients with ischemic syndromes: results from 3 randomized studies. Circulation 2005;111:3391-9.
67. Sangiorgi G, Rumberger JA, Severson A, et al. Arterial calcification and not lumen stenosis is correlated with atherosclerotic plaque burden in humans: a histologic study of 723 coronary artery segments using nondecalcifying methodology. J Am Coll Cardiol 1998;31:126-33.
68. Scharhag J, Herrmann M, Urhausen A, et al. Independent elevations of NT-proBNP and cardiac troponins in endurance athletes after prolonged strenuous exercise. Am Heart J 2005;150:1128-34.
69. Scharhag J, Schneider G, Urhausen A, et al. Athlete's heart. Right and left ventricular mass and function in male endurance athletes and untrained individuals determined by magnetic resonance imaging. J Am Coll Cardiol 2002;40:1856-63.
70. Schmermund A, Baumgart D, Adamzik M, et al. Comparison of EBCTand intracoronary ultrasound in detecting calcified and noncalcified plaques in patients with acute coronary syndromes and no or minimal to moderate angiographic coronary artery disease. Am J Cardiol 1998;81:141-6.
71. Schmermund A, Baumgart D, Görge G, et al. Measuring the effect of risk factors on coronary atherosclerosis: coronary calcium score versus angiographic disease severity. J Am Coll Cardiol 1998;31:1267-73.
72. Schmermund A, Möhlenkamp S, Berenbein S, et al., on behalf of the Heinz Nixdorf Study Investigative Group. Population-based assessment of subclinical coronary atherosclerosis using EBCT. Atherosclerosis 2006;185:177-82.
73. Schmermund A, Möhlenkamp S, Mathes P, et al. Bedeutung der Koronarkalkbestimmung in der Primärprävention. Z Kardiol 2005;94:Suppl 3:III/79-87.
74. Schmermund A, Möhlenkamp S, Stang A, at al., for the Heinz Nixdorf Recall Study Investigative Group. Assessment of clinically silent atherosclerotic disease and established and novel risk factors for predicting myocardial infarction and cardiac death in healthy middle-aged subjects: rationale and design of the Heinz Nixdorf Recall study. Am Heart J 2002:144:212-8.
75. Shaw LJ, Raggi P, Schisterman E, et al. Prognostic value of cardiac risk factors and coronary artery calcium screening for all-cause mortality. Radiology 2003;228:826-33.
76. Siegel AJ. Relative risk of sudden cardiac death during marathon running. Arch Intern Med 1997;157:1269.
77. Siegel AJ, Lewandrowski EL, Chun KY, et al. Changes in cardiac markers including BNP in runners after the Boston marathon. Am J Cardiol 2001;88:920-3.
78. Siegel AJ, Stec JJ, Lipinska I, et al. Effect of marathon running on inflammatory and hemostatic markers. Am J Cardiol 2001;88:918-20.
79. Siscovick DS, Weiss NS, Fletcher RH, et al.The incidence of primary cardiac arrest during vigorous exercise. N Engl J Med 1984;311:874-7.
80. 12SL ECG analysis with age & gender specific criteria. Physician's guide. PN 416791-004 revision A. Freiburg: GE Medical Systems IT 2000.
81. Steiner S, Niesser A, Ziegler S, et al. Endurance training increases the number of endothelial progenitor cells in patients with cardiovascular risk and coronary artery disease. Atherosclerosis 2005;181:305-10.
82. Suzuki K, Nakaji S, Yamada M, et al. Impact of a competitive marathon race on systemic cytokine and neutrophil responses. Med Sci Sports Exerc 2003;35:348-55.
83. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Heart rate variability. Standards of measurement, physiological interaction, and clinical use. Eur Heart J 1996;17:354-81.
84. Taylor A, Shaw LJ, Fayad Z, et al. Tracking atherosclerosis regression: a clinical tool in preventive cardiology. Atherosclerosis 2005;180:1-10.
85. Tedgui A, Mallat Z. Cytokines in atherosclerosis: pathogenic and regulatory pathways. Physiol Rev 2006;86:515-81.
86. Thomaszewski M, Charchar FJ, Przybycin M, et al. Strikingly low circulating CRP concentrations in ultramarathon runners independent of markers of adiposity. How low can you go? Arterioscler Thromb Vasc Biol 2003;23:1640-4.
87. Thompson PD, Buchner D, Pina IL, et al. Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease: a statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity and Metabolism (Subcommittee on Physical Activity). Circulation 2003;107:3109-16.
88. Thompson PD, Funk EJ, Carleton RA, et al. Incidence of death during jogging in Rhode Island from 1975 through 1980. JAMA 1982;247:2535-8.
89. Van Camp SP, Bloor CM, Müller FO, et al. Nontraumatic sports death in high school and college athletes. Med Sci Sports Exerc 1995;27:641-7.
90. Van der Wal AC, Becker AC, van der Loos CM, et al. Site of intimai rupture or erosion of thrombosed coronary atherosclerotic plaque is characterized by an inflammatory process irrespective of the dominant plaque morphology. Circulation 1994;89:36-44.
91. Vliegenthart R, Oudkerk M, Hofmann A, et al. Coronary calcification improves cardiovascular risk prediction in the elderly. Circulation 2005;112:572-7.
92. Voelker W, Koch D, Flachskampf FA, et al., für den Arbeitskreis "Standardisierung und LV-Funktion" der Arbeitsgruppe Kardiovaskulärer Ultraschall der DGK. Strukturierter Datensatz zur Befunddokumentation in der Echokardiographie - Version 2004. Z Kardiol 2004;93:987-1004 (www.dgk.org/Leitlinien).
93. Werner N, Kosiol S, Schiegl T, et al. Circulating endothelial progenitor cells and cardiovascular outcomes. N Engl J Med 2005;353:999-1007.
94. Whyte G, George K, Shave R, et. al. Impact of marathon running on cardiac structure and function in recreational runners. Clin Sci 2005;108:73-80.
95. Williams SV, Fihn SD, Gibbons RJ, ACC/AHA/ACPh/ASInt-Med. Guidelines for the management of patients with chronic stable angina: diagnosis and risk stratification. Ann Intern Med 2001;135:530-47.
96. Willich SN, Lewis M, Löwel H, et al. Physical exertion as a trigger of acute myocardial infarction. N Engl J Med 1993;329:1684-90.
97. Wilson PW, D'Agostino RB, Levy D, et al. Prediction of coronary heart disease using risk factor categories. Circulation 1998;97:1837-47.