Division of General Internal Medicine, Massachusetts General Hospital, Boston; Department of Internal Medicine, McLean Hospital, Belmont, Mass; Harvard Medical School, Boston, Mass.
Department of Human Biology, University of Cape Town, South Africa.
Am J Med. 2019 Feb;132(2):138-141. doi: 10.1016/j.amjmed.2018.09.015. Epub 2018 Oct 5.
While proficient cardiac resuscitation has improved survival following cardiac arrest during road races in Japan, this accomplishment does not address coronary artery disease as the underlying cause of an increasing frequency of cardiac arrest in middle-aged men during marathons and ironman triathlons in the United States since the year 2000. Based on the high prevalence of subclinical coronary artery disease by cardiac computed tomography in endurance athletes with low conventional cardiac risk-factor profiles, we recommend coronary artery calcium scores as a more reliable and independent predictor of incident cardiac events, including death, as validated among adults aged 30-46 years. Scores of over 100 Agatston units indicate a 10-year cardiac risk of 7.5%, at which additional measures for primary prevention are recommended, including aspirin, as shown conclusively to reduce first myocardial infarctions in same-aged men in a prospective double-blind controlled trial. Targeted screening for subclinical coronary atherosclerosis with coronary artery calcium scores is prudent to guide appropriately dosed aspirin use to mitigate the increasing frequency of sports-related sudden cardiac death due to plaque rupture.
虽然熟练的心脏复苏术提高了日本路跑比赛中心脏骤停后的存活率，但这一成就并没有解决冠状动脉疾病作为 2000 年以来美国马拉松和铁人三项比赛中年男性心脏骤停频率不断增加的根本原因。基于心脏计算机断层扫描在低传统心脏危险因素的耐力运动员中发现亚临床冠状动脉疾病的高患病率，我们建议将冠状动脉钙评分作为更可靠和独立的心脏事件（包括死亡）预测指标，这在 30-46 岁成年人中得到了验证。超过 100 个 Agatston 单位的分数表明 10 年的心脏风险为 7.5%，建议采取额外的一级预防措施，包括使用阿司匹林，前瞻性双盲对照试验明确显示该药物可降低同龄男性的首次心肌梗死。使用冠状动脉钙评分进行亚临床冠状动脉粥样硬化的靶向筛查是谨慎的，可以指导适当剂量的阿司匹林使用，以减轻由于斑块破裂导致的与运动相关的心脏性猝死的频率不断增加。
