575 Herz 31 · 2006 · Nr. 6 © Urban & Vogel 575 Herz 31 · 2006 · Nr. 6 © Urban & Vogel © Urban & Vogel 2006 Herz Coronary Atherosclerosis and Cardiovascular Risk in Masters Male Marathon Runners Rationale and Design of the “Marathon Study” Stefan Möhlenkamp 1 , Axel Schmermund 2 , Knut Kröger 3 , Gert Kerkhoff 4 , Martina Bröcker-Preuss 5, 6 , Volker Adams 7 , Martin Hensel 1 , David Kiefer 1 , Nils Lehmann 8 , Susanne Moebus 8 , Kirsten Leineweber 9 , Sigrid Elsenbruch 10 , Jörg Barkhausen 11 , Martin Halle 12 , Rainer Hambrecht 13 , Johannes Siegrist 14 , Klaus Mann 6 , Thomas Budde 4 , Karl-Heinz Jöckel 8 , Raimund Erbel 1 Abstract Background: Regular physical exercise is recommend- ed to reduce cardiovascular mortality. And yet, athero- sclerosis is the main cause of exercise-associated death in persons beyond age 35. The need for risk stratifica- tion in marathon runners is under discussion. The pre- dictive value of modern imaging- and non-imag- ing-based markers of risk that can be used for risk stratification in masters endurance athletes still de- serves exploration. Methods: Male runners > 50 years who have complet- ed 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 imag- ing-based and biochemical cardiovascular risk factors. Laboratory parameters including clinical chemistry, he- matology and hormone measurements are deter- mined. Lifestyle-related risk factors, psychosocial and socioeconomic variables are explored using standard- ized questionnaires. Coronary, carotid, femoral and aortic atherosclerosis is measured using electron- beam computed tomography and ultrasound. In addi- tion, 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 associa- tion 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 labo- ratory 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. Conclusion: This study should contribute to cardiovas- cular risk assessment in the growing number of masters marathon runners with a focus on assessing the predic- tive value of modern imaging techniques and biochemi- cal markers for comprehensive risk stratification. Arteriosklerose und kardiovaskuläre Risikofaktoren bei älteren männlichen Marathonläufern. Grundlage und Design der „Marathon-Studie“ Zusammenfassung Hintergrund: Regelmäßige körperliche Aktivität eig- net sich zur Prävention der Arteriosklerose und kardio- vaskulärer Ereignisse. Und dennoch ist die Arterioskle- rose die Hauptursache sportassoziierter Todesfälle jenseits des 35. Lebensjahrs. Der prädiktive Nutzen mo- derner bildgebender Verfahren und biochemischer Marker, die für eine Risikostratifizierung in Frage kom- men, wurde bei älteren Ausdauersportlern bislang nicht hinreichend untersucht. Methodik: Es werden Männer > 50 Jahre untersucht, die in den vergangenen 3 Jahren mindestens fünf Ma- rathonläufe absolviert haben und keine bekannte Herzkrankheit oder Angina pectoris und keinen Diabe- tes mellitus aufweisen. Etablierte Risikofaktoren sowie moderne bildgebende und biochemische Risikomarker werden gemessen. Lebensstilassoziierte, psychosozia- le und sozioökonomische Risikofaktoren werden mit standardisierten Fragebögen erhoben. Die Arterioskle- rose der Koronararterien, der Karotiden, der Femoralar- terien und der Aorta wird mittels Elektronenstrahlto- mographie und Ultraschall quantifiziert. Zusätzlich werden ein Ruhe-EKG, eine Fahrradergometrie und ei- ne Messung der Herzfrequenzvariabilität durchge- führt. Morphologie und Funktion des linken Ventrikels werden echokardiographisch und magnetresonanzto- Key Words: Marathon · Athero- sclerosis · Risk fac- tors · Electron-beam CT · Coronary artery disease · Cardiovas- cular screening 1 Clinic of Cardiology, West German Heart Center Es- sen, University Clinic Essen, Germany, 2 Cardiological Center Bethanien, Frankfurt/ Main, Germany, 3 Clinic of Angiology, Univer- sity Clinic Essen, Germany, 4 Clinik of Internal Medicine and Cardiology, Alfried Krupp Hospital, Essen, Ger- many, 5 Division of Clinical Chemistry and Laboratory Medicine, University Clinic Essen, Germany, 6 Clinic of Endocrinology, University Clinic Essen, Germany, 7 Clinic of Cardiology, Uni- versity of Leipzig, Heart Center Leipzig, Germany 8 Institute of Medical Infor- matics, Biometry and Epi- demiology, University Hos- pital Essen, Germany, 9 Institute of Pathophysiolo- gy, University Clinic Essen, Germany, 10 Clinic of Medical Sociology, University Hospital Essen, Germany, 11 Clinic of Diagnostic and In- terventional Radiology and Neuroradiology, University Clinic Essen, Germany, 12 Clinic of Preventive and Re- habilitative Sports Medi- cine, Technical University of Munich, Germany, 13 Clinic of Cardiology, Klini- kum Links der Weser, Bre- men, Germany, 14 Institute of Medical Sociol- ogy, University of Düssel- dorf, Germany. Herz 2006;31:575–85 DOI 10.1007/ s00059-006-2879-6