Prevalence and functional implication of silent coronary artery disease in marathon runners over 40 years of age: the MATCH 40 study

Abstract Background Marathon participation is becoming increasingly popular among individuals > 40 years of age. Little is known about the prevalence of subclinical coronary artery disease (CAD) and corresponding ischemia in this patient population. The study objectives are: 1) to characterize the prevalence of silent CAD in marathoners ≥ 40 years old using cardiac computed tomography angiography (CCT); and 2) if subclinical CAD was detected, to determine the functional significance of occult lesions by stress echocardiography (SE). Methods Marathoners aged > 40 years old who completed a full marathon between 2018-2019 were recruited to undergo a prospective CCT. Coronary artery stenosis was graded as zero, mild (1-49%), moderate (50-69%), or severe (>70%). All study participants diagnosed with mild to severe atherosclerotic CAD on CCT further underwent functional imaging with exercise treadmill SE. Results A total of 65 individuals (53±7 years, 65% males, 24±3 kg/m2) underwent a prospective CCT within 12 months of marathon completion. Of the total study population, 13 participants (20%) were diagnosed with CAD; 10 (77%) had mild disease, 1 (8%) had moderate disease, and 2 (15%) had severe disease by CCT. Despite the identification of subclinical CAD on CCT, none of the 13 patients had any evidence of inducible ischemia on SE. Conclusions This is the first study to incorporate both CCT and SE in the evaluation of subclinical CAD in marathoners > 40 years old. Although the overall prevalence of anatomical CAD was 20%, there was no evidence of functional ischemia in this highly competitive cohort.