July 06, 2017
2 min read

Running and the heart: Multiple marathons do not raise atherosclerosis risk

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A new study suggests that healthy, middle-aged men who participate in intensive endurance exercise such as running multiple marathon races do not have an increased risk for premature subclinical atherosclerosis.

“Our study shows that runners who have finished 20 marathons do not have stiffer arteries or more impaired vessel function than people of the same age who have finished five or zero marathons. We can conclude that marathon running itself is not a risk factor for atherosclerosis,” Axel Pressler, MD, head of the prevention center at Technical University in Munich, said in a press release.

Pressler and colleagues reviewed data on 97 men who previously ran marathons and were participating in the Munich marathon. The official distance of a marathon race is 26.2 miles.

The men studied did not have a history of CVD or regular medication use at baseline. Eighteen participants had a positive family history for CVD, and all runners were nonsmokers. The researchers reported extensive clinical assessment, including cardiopulmonary exercise testing, carotid ultrasound and ECG before the marathon race. Participants also provided information on their marathon preparation and number of completed marathons.

Before the Munich marathon, participants previously completed a median of eight half marathons (distance, 13.1 miles; n = 67), six full marathons (n = 87) and three ultramarathons (n = 14). An ultramarathon is any distance longer than 26.2 miles.

Runners trained an average of 59 km per week (approximately 36.6 miles) and a mean running distance of 1,639 km (approximately, 1,018 miles) per year.

The runners’ mean time for completing the Munich marathon was 3 hours, 45 minutes.

Mean peak oxygen uptake was 50.3 mL/kg per minute.

The researchers reported “normal mean values” for ankle-brachial index (1.21 ± 0.1), intima-media thickness (0.6 ± 0.14 mm), pulse wave velocity (8.7 ± 1.4 m per second), augmentation index (17 ± 12.7%) and reactive hyperemia index (1.96 ± 0.5) for the runners.

The mean age of runners in this study was 44 years (range, 22-64).

“Significant associations were found for age only, with a higher prevalence of abnormal values for intima-media thickness, augmentation index and pulse wave velocity in older runners, independent of exercise-related parameters. These findings indicate that repeated exposition to strenuous exercise does not seem to pose an independent risk factor for premature vascular impairment beyond the influence of age,” Pressler and colleagues wrote in the European Journal of Preventive Cardiology.


Key vascular parameters were not difference between participants who completed at least one ultramarathon compared with those who only completed half or full marathons before the Munich marathon, according to the findings.

“In this cohort of healthy, middle-aged male runners, no significant impact of exercise history, training history, number of previously completed half, full or ultramarathon races or marathon finishing time on markers of subclinical vascular impairment was observed. ... Our findings ... are in line with the majority of previous observations in not supporting an independent detrimental effect of (ultra)marathon running on vessel integrity. It should, however, be noted that repeated marathon running does also not appear to introduce beneficial effects on subclinical vascular structure and function,” the researchers concluded. – by Darlene Dobkowski

Disclosures: The main EnzyMagic trial was funded by Mucos Pharma. The researchers report no relevant financial disclosures.