Prospective long-term follow-up analysis of the cardiovascular system in marathon runners: study design of the Pro-MagIC study

Abstract

IntroductionProlonged strenuous exercise training may result in structural, functional and electrical cardiac remodelling, as well as vascular and myocardial injuries. However, the extent to which high-volume, intense exercise is associated with arrhythmias, myocardial fibrosis, coronary heart disease and pathological alterations of the vasculature remains unknown. In addition, there is no clear consensus on the clinical significance of these exercise-induced changes. Previous studies typically used cross-sectional designs and examined exercise-induced cardiovascular changes in small cohorts of athletes for up to 3–7 days of recovery. Long-term longitudinal studies investigating cardiovascular changes induced by prolonged strenuous exercise in large cohorts of athletes are needed to improve scientific understanding in this area.Methods and analysisIn this prospective observational monocenter study, 277 participants of the Beer, Marathon, Genetics, Inflammation and the Cardiovascular System (Be-MaGIC) study (ClinicalTrials.gov: NCT00933218) will be invited to participate in this 10-year follow-up study. A minimum target sample size of 130 participants will be included in the study. Participating athletes will be examined via the following: anthropometry, resting electrocardiography and echocardiography, blood sampling, retinal vessel diameters, carotid sonography and cardiopulmonary exercise testing, including exercise electrocardiography.DiscussionThis longitudinal study will provide comprehensive data on physiological changes in the cardiovascular system and the development of pathologies after a 10-year period of prolonged and strenuous endurance exercise. Since the participants will have engaged in a wide range of training loads and competitive race events, this study will provide useful risk factor determinants and training load cut-off values. The primary endpoint is the association between the exercise-induced increase in cardiac troponin during the Munich marathon 2009 and the decline in right ventricular ejection fraction over the next 10 years.Trial registration numberNCT04166903.

Inflammatory response to a marathon run in amateur athletes

“…Currently, there is little data available regarding the long-term effects of intense endurance activity on the inflammatory response. However, a prospective, long-term study of at least 130 marathon runners is currently underway by Schoenfeld et al [32] and may provide important information on this topic. The aim of this study is to assess the physiological response of the cardiovascular system and potential abnormalities after 10 years of long-term vigorous endurance exercise.…”

Could Repeated Cardio-Renal Injury Trigger Late Cardiovascular Sequelae in Extreme Endurance Athletes?

“…To what extent long-term pathophysiological mechanisms induced by cardio-renal interactions are really at work in extreme endurance athletes remains speculative and must be evaluated in future studies. For instance, this is the objective of a prospective long-term follow-up analysis, the Pro-MagIC study [138]. Finally, all these efforts will help to provide the foundation for improved counseling, training, and care of current and prospective athletes who are interested in EEE.…”

The Effects of Omega-3 Fatty Acid Supplementation on the Lipid Profile and Cardiovascular Markers Following Downhill Running in Long-Distance Runners

“…The observed trend of increasing participation rates in marathon and ultramarathon events indicates popularity of this form of recreational and competitive sport (ARRS—Homepage, https://arrs.run/ , accessed on 23 July 2021; Reusser et al, 2021 ). Numerous studies have shown a variety of health benefits, including the improvement in sport performance and cardiovascular health ( Schoenfeld et al, 2020 ), induction of functional changes in the neuromuscular system and modulation of inflammation ( Burkule et al, 2016 , Knechtle and Nikoladis 2018). Nevertheless, marathon runners also face health risks ( Jastrzębski et al, 2009 ; Knechtle et al, 2018 ; Neilen et al, 2006).…”

“…Hypertrophic cardiomyopathy and coronary vessel anomalies are the main risk factors of cardiovascular disease among athletes. Young athletes (<35 years of age) are at a lower risk of cardiovascular disease compared to athletes aged 35 and older, among whom the most frequent cause of SCD is coronary atheromatosis ( Predel, 2014 ; Schoenfeld et al, 2020 ). Given the above, developing optimal dietary support to protect the cardiovascular system of endurance athletes, marathon and ultramarathon runners in particular, can help reduce their risk of SCD.…”