Male Marathoners and Coronary Artery Calcium

Study Questions:

Is there an association between elevated coronary artery calcium (CAC) scores observed in male long-term marathon runners and cardiovascular risk profiles?


Male marathoners who ran one or more marathons per year for at least 25 consecutive years were recruited for the study. CAC was assessed using coronary computed tomography angiography. Coronary artery disease (CAD) risk factors were assessed with risk factor questionnaire, 12-lead electrocardiogram, serum lipid panel, height, weight, resting blood pressure, and heart rate.


Fifty males, mean age 59 ± 0.9 yr with a combined total of 3,510 marathons (27-171), had a mean body mass index of 22.44 ± 0.4 kg/m2, high-density lipoprotein and low-density lipoprotein cholesterols of 58 ± 1.6 and 112 ± 3.7 mg/dL, and could be otherwise characterized as physically active year-round. The entire group was stratified by CAC scores into subgroups of zero, low, moderate, and extensive scores (16 had 0, 12 had 1-100, 12 had 101-400, and 10 had >400). Older age at onset of running and older age at first marathon were positively associated with higher CAC scores. In terms of CAD risk factors, age, pack-years of smoking, low-density lipoprotein cholesterol, and total number of risk factors were also positively correlated with CAC score. There was no statistical difference in the volume of running or the number of marathons run among the four groups.


In this study of 50 male marathoners, marathoners with moderate to extensive CAC were older, started running at an older age, were older when they ran their first marathon, and had more CAD risk factors (including higher rates of previous tobacco use and prevalence of hyperlipidemia) compared with marathoners with no CAC. However, there were no significant differences in the number of marathons completed or average body mass index, suggesting that past lifestyle choices play a greater role in CAC score than volume of marathon running.


Compared with female long-term marathoners, male marathoners have higher CAC scores and greater risk of sudden cardiac arrest and death during and immediately after a marathon. Among male long-term marathoners, CAC scores and CAD are related to CAD risk factors (age and smoking) and not the number marathons run or years of running. This suggests that among lifelong endurance athletes, more endurance exercise is not associated with an increased risk of coronary artery plaque formation.

Clinical Topics: Diabetes and Cardiometabolic Disease, Prevention, Sports and Exercise Cardiology, Atherosclerotic Disease (CAD/PAD), Exercise

Keywords: Running, Exercise, Coronary Artery Disease, Atherosclerosis, Plaque, Atherosclerotic, Risk Factors

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