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Prerace aspirin to protect susceptible runners from cardiac arrest during marathons: is opportunity knocking?

Siegel AJ - Open Heart (2015)

Bottom Line: An evidence-based strategy for prevention is considered based on identifying atherothrombosis as the underlying cause in this susceptible subgroup.Review of all articles on PubMed related to acute cardiac events during marathons.Inflammatory biomarkers predicting acute cardiac events and hypercoagulability with in vivo platelet activation were demonstrated in same-aged asymptomatic middle-aged men during marathons.

View Article: PubMed Central - PubMed

Affiliation: Internal Medicine , McLean Hospital , Belmont, Massachusetts , USA ; Harvard Medical School , Boston, Massachusetts , USA.

ABSTRACT
While endurance exercise such as marathon training is cardioprotective, an increasing frequency of race-related cardiac arrests and sudden death has been observed in middle-aged men since the year 2000. An evidence-based strategy for prevention is considered based on identifying atherothrombosis as the underlying cause in this susceptible subgroup. Review of all articles on PubMed related to acute cardiac events during marathons. Male gender and the marathon compared with the half-marathon were identified as significant risk factors for race-related cardiac arrests, which events increased 2.3-fold in the latter half of a 10-year prospective registry beginning in the year 2000. There were 50 cardiac arrests in runners who were 86% male with a mean age of 42 years. The main cause of sudden death was atherosclerotic heart disease in those over the age of 40 including myocardial infarction in 12 of 13 (93%) cases over the age of 45 as assessed retrospectively. Inflammatory biomarkers predicting acute cardiac events and hypercoagulability with in vivo platelet activation were demonstrated in same-aged asymptomatic middle-aged men during marathons. Excess cardiac morbidity and mortality in middle-aged men during marathons is mediated by atherothrombosis which may render non-obstructive coronary atherosclerotic plaques vulnerable to rupture. Prerace low-dose aspirin usage is prudent to protect susceptible runners from a high, if transient, risk for cardiac arrest during races as evidence-based to prevent first myocardial infarctions in same-aged healthy men.

No MeSH data available.


Related in: MedlinePlus

Pheidippides’ sudden cardiac death in the Atheneum in 490 B.C. after declaring victory over the invading Persian army on the Plains of Marathon (by anonymous).
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OPENHRT2014000102F1: Pheidippides’ sudden cardiac death in the Atheneum in 490 B.C. after declaring victory over the invading Persian army on the Plains of Marathon (by anonymous).

Mentions: Perhaps reprising the index case of Pheidippides in 490 B.C., (figure 1) these findings indicate a high, if transient, risk for atherothrombosis during marathons, which may cause low-profile coronary atherosclerotic plaques to morph into the culprit lesions of acute coronary thrombosis.1819 Coronary plaque rupture triggering type 1 acute myocardial infarction was observed in vivo in two runners during postrace coronary angiography after the 2011 Boston marathon.2021 The increase in cardiac arrests in susceptible runners during marathons may be seen as a specific clinical example of exertional sudden cardiac death as occurs in on-duty police officers.2223 Inflammation-induced atherothrombosis also accounts for the increased cardiac risk of systemic infections such as community-acquired bacteraemia and scrub typhus.2425


Prerace aspirin to protect susceptible runners from cardiac arrest during marathons: is opportunity knocking?

Siegel AJ - Open Heart (2015)

Pheidippides’ sudden cardiac death in the Atheneum in 490 B.C. after declaring victory over the invading Persian army on the Plains of Marathon (by anonymous).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4493166&req=5

OPENHRT2014000102F1: Pheidippides’ sudden cardiac death in the Atheneum in 490 B.C. after declaring victory over the invading Persian army on the Plains of Marathon (by anonymous).
Mentions: Perhaps reprising the index case of Pheidippides in 490 B.C., (figure 1) these findings indicate a high, if transient, risk for atherothrombosis during marathons, which may cause low-profile coronary atherosclerotic plaques to morph into the culprit lesions of acute coronary thrombosis.1819 Coronary plaque rupture triggering type 1 acute myocardial infarction was observed in vivo in two runners during postrace coronary angiography after the 2011 Boston marathon.2021 The increase in cardiac arrests in susceptible runners during marathons may be seen as a specific clinical example of exertional sudden cardiac death as occurs in on-duty police officers.2223 Inflammation-induced atherothrombosis also accounts for the increased cardiac risk of systemic infections such as community-acquired bacteraemia and scrub typhus.2425

Bottom Line: An evidence-based strategy for prevention is considered based on identifying atherothrombosis as the underlying cause in this susceptible subgroup.Review of all articles on PubMed related to acute cardiac events during marathons.Inflammatory biomarkers predicting acute cardiac events and hypercoagulability with in vivo platelet activation were demonstrated in same-aged asymptomatic middle-aged men during marathons.

View Article: PubMed Central - PubMed

Affiliation: Internal Medicine , McLean Hospital , Belmont, Massachusetts , USA ; Harvard Medical School , Boston, Massachusetts , USA.

ABSTRACT
While endurance exercise such as marathon training is cardioprotective, an increasing frequency of race-related cardiac arrests and sudden death has been observed in middle-aged men since the year 2000. An evidence-based strategy for prevention is considered based on identifying atherothrombosis as the underlying cause in this susceptible subgroup. Review of all articles on PubMed related to acute cardiac events during marathons. Male gender and the marathon compared with the half-marathon were identified as significant risk factors for race-related cardiac arrests, which events increased 2.3-fold in the latter half of a 10-year prospective registry beginning in the year 2000. There were 50 cardiac arrests in runners who were 86% male with a mean age of 42 years. The main cause of sudden death was atherosclerotic heart disease in those over the age of 40 including myocardial infarction in 12 of 13 (93%) cases over the age of 45 as assessed retrospectively. Inflammatory biomarkers predicting acute cardiac events and hypercoagulability with in vivo platelet activation were demonstrated in same-aged asymptomatic middle-aged men during marathons. Excess cardiac morbidity and mortality in middle-aged men during marathons is mediated by atherothrombosis which may render non-obstructive coronary atherosclerotic plaques vulnerable to rupture. Prerace low-dose aspirin usage is prudent to protect susceptible runners from a high, if transient, risk for cardiac arrest during races as evidence-based to prevent first myocardial infarctions in same-aged healthy men.

No MeSH data available.


Related in: MedlinePlus