Möhlenkamp Stefan, Schmermund Axel, Kröger Knut, Kerkhoff Gert, Bröcker-Preuss Martina, Adams Volker, Hensel Martin, Kiefer David, Lehmann Nils, Moebus Susanne, Leineweber Kirsten, Elsenbruch Sigrid, Barkhausen Jörg, Halle Martin, Hambrecht Rainer, Siegrist Johannes, Mann Klaus, Budde Thomas, Jöckel Karl-Heinz, Erbel Raimund
Clinic of Cardiology, West German Heart Center Essen, University Clinic Essen, Essen, Germany.
Herz. 2006 Sep;31(6):575-85. doi: 10.1007/s00059-006-2879-6.
Regular physical exercise is recommended to reduce cardiovascular mortality. And yet, atherosclerosis is the main cause of exercise-associated death in persons beyond age 35. The need for risk stratification in marathon runners is under discussion. The predictive value of modern imaging- and non-imaging-based markers of risk that can be used for risk stratification in masters endurance athletes still deserves exploration.
Male runners > 50 years who have completed at least five marathon races during the preceding 3 years and do not suffer from coronary artery disease, angina nor diabetes mellitus are studied to assess the predictive value of established and modern imaging- based and biochemical cardiovascular risk factors. Laboratory parameters including clinical chemistry, hematology and hormone measurements are determined. Lifestyle-related risk factors, psychosocial and socioeconomic variables are explored using standardized questionnaires. Coronary, carotid, femoral and aortic atherosclerosis is measured using electronbeam computed tomography and ultrasound. In addition, a resting ECG, a bicycle stress test and heart rate variability are performed. Myocardial morphology and function are assessed using echocardiography and magnetic resonance imaging. Participants are invited to compete in a marathon race to quantify the association of coronary atherosclerosis with marathon-related changes of cardiac troponin levels and the extent of marathon-induced inflammation. At the cellular level, the effect on the amount of circulating progenitor cells (EPCs) is determined by FACS analysis. Changes in laboratory parameters and hormone levels are also studied. Annual long-term follow-up including hospital records and death certificates is performed. Data are compared with those from a general unselected cohort from the Heinz Nixdorf Recall Study.
This study should contribute to cardiovascular risk assessment in the growing number of masters marathon runners with a focus on assessing the predictive value of modern imaging techniques and biochemical markers for comprehensive risk stratification.
建议进行规律的体育锻炼以降低心血管疾病死亡率。然而，动脉粥样硬化是35岁以上人群运动相关死亡的主要原因。马拉松运动员风险分层的必要性正在讨论中。可用于老年耐力运动员风险分层的基于现代成像和非成像的风险标志物的预测价值仍值得探索。
对年龄大于50岁、在过去3年中至少完成5次马拉松比赛且无冠状动脉疾病、心绞痛或糖尿病的男性跑步者进行研究，以评估既定的和基于现代成像及生化的心血管危险因素的预测价值。测定包括临床化学、血液学和激素测量在内的实验室参数。使用标准化问卷探索与生活方式相关的危险因素、心理社会和社会经济变量。使用电子束计算机断层扫描和超声测量冠状动脉、颈动脉、股动脉和主动脉的动脉粥样硬化情况。此外，进行静息心电图、自行车运动试验和心率变异性检测。使用超声心动图和磁共振成像评估心肌形态和功能。邀请参与者参加马拉松比赛，以量化冠状动脉粥样硬化与马拉松相关的心肌肌钙蛋白水平变化以及马拉松引起的炎症程度之间的关联。在细胞水平上，通过流式细胞术分析确定对循环祖细胞（EPCs）数量的影响。还研究实验室参数和激素水平的变化。进行年度长期随访，包括医院记录和死亡证明。将数据与来自海因茨·尼克斯多夫召回研究的未选择的一般队列的数据进行比较。
本研究应有助于对越来越多的老年马拉松运动员进行心血管风险评估，重点是评估现代成像技术和生化标志物对全面风险分层的预测价值。
