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

Nat Clin Pract Cardiovasc Med. 2007 Jul;4(7):396-401. doi: 10.1038/ncpcardio0926.


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.

Publication types

  • Case Reports

MeSH terms

  • Coronary Angiography
  • Coronary Artery Bypass
  • Coronary Artery Disease* / diagnostic imaging
  • Coronary Artery Disease* / therapy
  • Exercise / physiology*
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction / genetics
  • Running / physiology*
  • Ultrasonography, Doppler
  • Ultrasonography, Interventional