The Dynamics of Cardiovascular Biomarkers in non-Elite Marathon Runners

Abstract

The number of recreational/non-elite athletes participating in marathons is increasing, but data regarding impact of endurance exercise on cardiovascular health are conflicting. This study evaluated 79 recreational athletes of the 2016 Barcelona Marathon (72% men; mean age 39 ± 6 years; 71% ≥35 years). Blood samples were collected at baseline (24-48 h before the race), immediately after the race (1-2 h after the race), and 48-h post-race. Amino-terminal pro-B type natriuretic peptide (NT-proBNP, a marker of myocardial strain), ST2 (a marker of extracellular matrix remodeling and fibrosis, inflammation, and myocardial strain), and high-sensitivity troponin T (hs-TnT, a marker of myocyte stress/injury) were assayed. The median (interquartile range, IQR) years of training was 7 (5-11) years and median (IQR) weekly training hours was 6 (5-8) h/week, respectively. The median (IQR) race time (h:min:s) was 3:32:44 (3:18:50-3:51:46). Echocardiographic indices were within normal ranges. Immediately after the race, blood concentration of the three cardiac biomarkers increased significantly, with 1.3-, 1.6-, and 16-fold increases in NT-proBNP, ST2, and hs-TnT, respectively. We found an inverse relationship between weekly training hours and increased ST2 (p = 0.007), and a direct relationship between race time and increased hs-TnT (p < 0.001) and ST2 (p = 0.05). Our findings indicate that preparation for and participation in marathon running may affect multiple pathways affecting the cardiovascular system. More data and long-term follow-up studies in non-elite and elite athletes are needed.

Race duration and blood pressure are major predictors of exercise-induced cardiac troponin elevation

“…In this study, there was a consistent inverse relation between cTn levels and race duration in both bivariate and multiple regression models ( Table 2, Supplementary Table 3). Previous studies assessing the relationship between the cTn response and race duration have been conflicting: Some studies found a direct correlation (3,16,17), whereas others found an inverse correlation (4,13) or no correlation (11,12,18). Although race duration is a readily available parameter, the interpretation of this variable is complex.…”

The “Extreme Exercise Hypothesis”: Recent Findings and Cardiovascular Health Implications

“…Exercise-induced increases in cardiac biomarkers, such as troponin, a marker of cardiomyocyte damage, and B-type natriuretic peptide (BNP), a marker of myocardial stress, are common in athletes after endurance exercise [ 29 ]. Recent studies explored the impact of endurance exercise on novel cardiac biomarkers, such as galectin-3, a marker of myocardial fibrosis, [ 30 ] and soluble suppression of tumorigenicity-2 (sST2), a marker of extracellular matrix remodeling and fibrosis [ 31 ]. Resting levels of galectin-3 were higher in athletes ( n = 21) compared to controls ( n = 21), whereas significant increases were observed following a 30-km run (12.8 ± 3.4 to 19.9 ± 3.9 ng/ml, p < 0.001) [ 30 ].…”

“…Similarly, sST2 concentrations increased following a marathon (34.2 to 54.2 ng/ml, p < 0.001), with 68 of 79 athletes (86%) demonstrating a concentration above the upper reference limit. Complete normalization of sST2 levels occurred within 48 h [ 31 ]. Increases in cardiac biomarkers are modest and transient, but the clinical implications of these elevations are unknown.…”

Cardiac Biomarker Release After Exercise in Healthy Children and Adolescents: A Systematic Review and Meta-Analysis

“…Based on studies with adult participants other individual characteristics, other than age, might influence cardiac biomarkers release. Sex differences in cTn and NT-proBNP are controversial (4,6,10,23,30,36,56,80). Previous exercise experience has been negatively associated with cTn release (10,21,47,76) while training load might be not associated with biomarker appearance (18,21,28,33,68,79).…”