A highly trained marathon runner had progressive angina pectoris. His exercise stress test showed ischemia, and selective coronary angiography demonstrated a 99% obstruction of the left anterior descending coronary artery. A lipid analysis revealed normal total serum cholesterol levels with elevated high-density lipoprotein and markedly decreased low-density lipoprotein fractions. The remaining risk factors for coronary artery atherosclerosis were also absent. Unlike previous reports of ischemic heart disease in runners, in which the level of conditioning has been low, the duration of running brief, the risk factors operative, or the documentation weak, this patient represents unequivocal evidence that a long-distance marathon runner's life-style is not necessarily protective against the progression of coronary atherosclerosis.
Handler JB, Asay RW, Warren SE, Shea PM. Symptomatic Coronary Artery Disease in a Marathon Runner. JAMA. 1982;248(6):717–719. doi:10.1001/jama.1982.03330060057035
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