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Prevalence and Functional Implication of Silent Coronary Artery Disease in Marathon Runners Over 40 Years of Age: The
Christopher T Lee1,2, Skyler E Eastman1, Liane A Arcinas1,2
1Institute of Cardiovascular Sciences, St. Boniface Albrechtsen Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada.
Insights
In older marathon runners, 20% had silent coronary artery disease (CAD) detected by CCT, but none showed ischemia on stress echocardiography (SE), suggesting anatomical CAD doesn't always mean functional impairment.
Area of Science:
- Cardiology
- Sports Medicine
- Preventive Cardiology
Background:
- Marathon running is increasingly popular in adults over 40.
- Prevalence of subclinical coronary artery disease (CAD) and ischemia in this group is largely unknown.
Purpose of the Study:
- To determine the prevalence of silent CAD in marathoners aged 40+ using cardiac computed tomography angiography (CCT).
- To assess the functional significance of detected subclinical CAD using stress echocardiography (SE).
Main Methods:
- Prospective CCT performed on marathoners (≥40 years) within 12 months of race completion.
- Coronary artery stenosis graded (mild, moderate, severe).
- Participants with mild-to-severe CAD underwent exercise treadmill stress echocardiography (SE).
Main Results:
- 65 participants (53±7 years, 65% male) completed CCT.
- 20% (13 participants) diagnosed with CAD; 15% had severe stenosis.
- No participants with CAD showed evidence of inducible ischemia on SE.
Conclusions:
- This study is the first to combine CCT and SE for subclinical CAD evaluation in marathoners ≥40.
- While anatomical CAD prevalence was 20%, no functional ischemia was observed in this cohort.
Background:
Marathon participation is becoming increasingly popular among individuals ≥40 years of age. Little is known about the prevalence of subclinical coronary artery disease (CAD) and corresponding ischemia in this patient population. The study objectives are: (1) to characterize the prevalence of silent CAD in marathoners ≥ 40 years old using cardiac computed tomography angiography (CCT); and (2) if subclinical CAD was detected, to determine the functional significance of occult lesions by stress echocardiography (SE).
Methods:
Marathoners aged ≥ 40 years who completed a full marathon between 2018 and 2019 were recruited to undergo a prospective CCT. Coronary artery stenosis was graded as zero, mild (1%-49%), moderate (50%-69%), or severe (> 70%). All study participants diagnosed with mild-to-severe atherosclerotic CAD on CCT further underwent functional imaging with exercise treadmill SE.
Results:
A total of 65 individuals (53 ± 7 years, 65% males, 24 ± 3 kg/m2) underwent a prospective CCT within 12 months of marathon completion. Of the total study population, 13 participants (20%) were diagnosed with CAD, of whom 10 (77%) had mild disease, 1 (8%) had moderate disease, and 2 (15%) had severe disease by CCT. Despite the identification of subclinical CAD on CCT, none of the 13 patients had any evidence of inducible ischemia on SE.
Conclusions:
This is the first study to incorporate both CCT and SE in the evaluation of subclinical CAD in marathoners ≥40 years old. Although the overall prevalence of anatomic CAD was 20%, there was no evidence of functional ischemia in this highly competitive cohort.
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