WJCD> Vol.3 No.5A, August 2013

The rationale for pre-race aspirin to protect susceptible runners from sudden cardiac death during marathons: Deconstructing the Pheidippides conundrum

ABSTRACT

Objectives: While endurance exercise such as training for marathons is cardioprotective, cardiac arrests and sudden death occur in previously healthy runners during races predominantly in middle-aged males due to atherosclerotic heart disease. Recent evidence related to this problem is reviewed herein including epidemiologic studies and findings related to acute cardiac risk in asymptomatic middle-aged male runners during races. Method: Literature review related to the above. Findings: The risks of cardiac arrest and sudden death were 1 in 57,002 and 1 in 171,005 respectively in runners with a mean age of 49.7 years among 1,710,052 participants in marathons in the United States since 1980. Atherosclerotic heart disease was the cause of death in over 90% of cases in two retrospective studies and a greater than two-fold increase in cardiac arrests was observed in middle-aged men in the latter half of a 10-year prospective registry beginning in the year 2000. Asymptomatic middle-aged male runners showed elevated biomarkers of inflammation such as interleukin-6, C-reactive protein together with procoagulant effects including in vivo platelet activation, indicating susceptibility to atherothrombosis. Conclusions: Antithrombotic prophylaxis is evidence-based by validated clinical paradigms to prevent cardiac arrest and sudden death in susceptibile marathon runners at high risk for atherothrombosis during races.

KEYWORDS


Cite this paper

Siegel, A. (2013) The rationale for pre-race aspirin to protect susceptible runners from sudden cardiac death during marathons: Deconstructing the Pheidippides conundrum. World Journal of Cardiovascular Diseases, 3, 17-20. doi: 10.4236/wjcd.2013.35A003.

References

[1] Williams, H. and Arnold, H.D. (1899) The effects of violent and prolonged muscular exercise upon the heart. Philadelphia Medical Journal, 3, 1233-1235.
[2] Mathews, S.C., Narotsky, D.L., Berbholt, D.L., et al. (2012) Mortality among marathon runners in the United States, 2000-2009. The American Journal of Sports Medicine, 40, 1495-1500. doi:10.1177/0363546512444555
[3] Webner, D., Duprey, K.M., Drezner, J.A., et al. (2012) Sudden cardiac arrest and death in United States Marathons. Medicine & Science in Sports & Exercise, 44, 1843-1845. doi:10.1249/MSS.0b013e318258b59a
[4] Kim, J.H., Malhotra, R., Chiampas, G., et al. (2012) For the RACER Study Group. The New England Journal of Medicine, 366, 130-142. doi:10.1056/NEJMoa1106468
[5] Siegel, A.J. (2012) Phaedippides Redux; reducing acute cardiac risk during marathon running. The American Journal of Medicine, 125, 630-635. doi:10.1016/j.amjmed.2011.11.008
[6] Siegel, A.J., Silverman, L.M. and Lopez, M.S. (1980) Creatine kinase elevations in marathon runners: Relationship to training and competition. Yale Journal of Biology and Medicine, 53, 275-279.
[7] Kratz, A., Lewandrowski, K.B., Siegel, A.J., et al. (2002) Effect of marathon running on hematological and biochemical laboratory parameters including cardiac markers. American Journal of Clinical Pathology, 118, 856-863. doi:10.1309/14TY-2TDJ-1X0Y-1V6V
[8] Siegel, A.J., Verbalis, J.G., Clement, S., et al. (2007) Hyponatremia in Marathon Runners due to Inappropriate Arginine Vasopressin Secretion. The American Journal of Medicine, 120, 461.e11-461.e17.
[9] Saenz, A.J., Lee-Lewandrowsi, E., Wood, M.J., et al. (2006) Measurement of a plasma stroke biomarker panel and cardiac troponin T in marathon runners before and after the 2005 Boston marathon. American Journal of Clinical Pathology, 126, 1-5. doi:10.1309/D7QUF0HJMCYYYY5A
[10] Libby, P. and Crea, F. (2010) Clinical implications of inflammation for cardiovascular primary prevention. European Heart Journal, 31, 777-783. doi:10.1093/eurheartj/ehq022
[11] Siegel, A.J., Stec, J.J., Lipinska, I., et al. (2001) Effect of marathon running on inflammatory and hemostatic markers. American Journal of Cardiology, 88, 35-38. doi:10.1016/S0002-9149(01)01909-9
[12] Kratz, A., Wood, M.J., Siegel, A.J., et al. (2006) Effects of marathon running on platelet activation markers. Direct evidence for in vivo platelet activation. American Journal of Clinical Pathology, 125, 296-300.
[13] Albano, A.J., Thompson, P.D. and Kapur, N.K. (2012) Acute coronary thrombosis in Boston marathon runners. The New England Journal of Medicine, 366, 184-185. doi:10.1056/NEJMc1111015
[14] Steering Committee of the Physicians’ Health Study Research Group (1989) Final report on the aspirin component of the ongoing Physicians’ Health Study. The New England Journal of Medicine, 321, 129-135. doi:10.1056/NEJM198907203210301
[15] Hennekens, C.H. and Dalen, J.E. (2013) Aspirin in the treatment and prevention of cardiovascular disease: Past and current perspectives and future directions. The American Journal of Medicine, 126, 373-378. doi:10.1016/j.amjmed.2012.12.013
[16] Grosser, T., Fries, S., Lawson, J.A., et al. (2013) Drug resistance and pseudoresistance: an unintended consequence of enteric coated aspirin. Circulation, 127, 377-385. doi:10.1161/CIRCULATIONAHA.112.117283
[17] Ray, W.A., Murray, K.T., Hall, K., et al. (2012) Azithromycin and risk of cardiovascular death. The New England Journal of Medicine, 366, 1881-1890. doi:10.1056/NEJMoa1003833
[18] Weiler, R., Goldstein, M.A., Beasley, I., et al. (2012) What can we do to reduce the number of tragic cardiac events in sport? British Journal of Sports Medicine, 46, 897-898. doi:10.1136/bjsports-2012-091252
[19] Mohlenkamp, S., Lehmann, N., Breuckmann, F., et al. (2008) Running: The risk of coronary events: Relevance and prognostic relevance of coronary atherosclerosis in marathon runners. European Heart Journal, 29, 1903-1910. doi:10.1093/eurheartj/ehn163
[20] Yared, K. and Wood, M.J. (2009) Is marathon running hazardous to your cardiovascular health? The jury is still out. Radiology, 251, 3-5. doi:10.1148/radiol.2511090041
[21] Greche, A.L. (2013) Can intense endurance exercise cause myocardial damage and fibrosis? Current Sports medicine reports. Medicine & Science in Sports & Exercise, 12, 63-69.
[22] Marijon, E., Tafflet, M., Celermajer, D.S., Dumas, F., Perier, M.C., Mustafic, H., Toussaint, J.F., Desnos, M., Fieu, M., Benameur, N., LeHeuzey, J.Y., Empana, J.P. and Jouven, X. (2011) Sports-related sudden death in the general population. Circulation, 124, 672-681. doi:10.1161/CIRCULATIONAHA.110.008979
[23] Frieden, T.R. and Berwick, D.M. (2011) The “Million Hearts” initiative—Preventing heart attacks and strokes. The New England Journal of Medicine, 365, e27. doi:10.1056/NEJMp1110421

comments powered by Disqus

Copyright © 2014 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.