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On the paradox of exercise: coronary atherosclerosis in an apparently healthy marathon runner

Nature Clinical Practice Cardiovascular Medicine volume 4, pages 396–401 (2007)Cite this article

Abstract

Background An asymptomatic and apparently healthy 64-year-old marathon runner underwent comprehensive cardiovascular risk assessment as part of a prospective study on calcified coronary plaque burden in master marathon runners. His profile suggested a low 10-year cardiovascular risk.

Investigations Conventional risk-factor assessment, coronary artery calcium quantification, bicycle stress test, echocardiography, coronary angiography, intravascular ultrasonography, including virtual histology, and intracoronary Doppler ultrasonography.

Diagnosis Severe coronary atherosclerosis of the left anterior descending, mid left circumflex, and left main arteries.

Management Stenting of the left anterior descending artery, CABG surgery, and intensive risk-factor modification. The patient was also advised against participating in future marathon competitions.

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Figure 1: Coronary angiogram demonstrating marked lumen reduction in the mid LAD and mid LCX (arrows)
Figure 2: Intracoronary Doppler ultrasound scans demonstrating blood flow in the stenosed LAD and the non-stenosed RCA
Figure 3: Intravascular ultrasound virtual histology image of a single plaque in the left anterior descending artery, demonstrating a relatively high amount of necrotic core plaque component (14%), as marked in red
Figure 4: Intracoronary Doppler ultrasound scan of the distal LAD after stent deployment

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Authors and Affiliations

  1. and R Erbel is Professor of Medicine and Cardiology and Head of the Department of Cardiology, S Möhlenkamp is Associate Professor of Medicine and Cardiology, D Böse is a Fellow of Cardiology, all at the West-German Heart Center Essen, and AA Mahabadi is a fourth-year student at the Medical School, and G Heusch is Professor of Medicine and Pathophysiology and Head of the Institute of Pathophysiology, at the University Clinic Duisburg-Essen, Essen, Germany.,

    Stefan Möhlenkamp, Dirk Böse, Amir Abbas Mahabadi, Gerd Heusch & Raimund Erbel

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  1. Stefan Möhlenkamp
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Corresponding author

Correspondence to Stefan Möhlenkamp.

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The authors declare no competing financial interests.

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Möhlenkamp, S., Böse, D., Mahabadi, A. et al. On the paradox of exercise: coronary atherosclerosis in an apparently healthy marathon runner. Nat Rev Cardiol 4, 396–401 (2007). https://doi.org/10.1038/ncpcardio0926

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