Occult coronary artery disease in middle-aged sportsmen with a low cardiovascular risk score: The Measuring Athlete's Risk of Cardiovascular Events (MARC) study

Thijs L. Braber*, Arend Mosterd, Niek H. Prakken, Rienk Rienks, Hendrik M. Nathoe, Willem P. Mali, Pieter A. Doevendans, Frank J. Backx, Michiel L. Bots, Diederick E. Grobbee, Birgitta K. Velthuis

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

33 Citations (Scopus)

Abstract

Background Most exercise-related cardiac arrests in men aged 45 years are due to coronary artery disease (CAD). The current sports medical evaluation (SME) of middle-aged sportsmen includes medical history, physical examination and resting and exercise electrocardiography (ECG). We investigated the added value of low-dose cardiac computed tomography (CCT) - both non-contrast CT for coronary artery calcium scoring (CACS) and contrast-enhanced coronary CT angiography (CCTA) - in order to detect occult CAD in asymptomatic recreational sportsmen aged 45 years without known cardiovascular disease.

Methods Following a normal SME (with resting and bicycle exercise ECG), 318 asymptomatic sportsmen underwent CCT and 300 (94%) had a low European Society of Cardiology Systematic Coronary Risk Evaluation (SCORE) risk. Occult CAD was defined as a CACS 100 Agatston units (AU) or obstructive (50%) luminal stenosis on CCTA. The number needed to screen (NNS) in order to prevent one cardiovascular event within 5 years with statin treatment was estimated.

Results Fifty-two (16.4%, 95% confidence interval (CI): 12.7-20.8%) of 318 participants had a CACS 100 AU. The CCTA identified an additional eight participants with luminal narrowing 50% (and a CACS

Conclusions Coronary CT detects occult CAD in almost one in five asymptomatic sportsmen aged 45 years after a normal SME that included resting and bicycle exercise ECG. CACS reveals most of the relevant CAD with limited additional value of contrast-enhanced CCTA. The NNS in order to prevent one cardiovascular event compares favourably to that of other screening tests.

Original languageEnglish
Pages (from-to)1677-1684
Number of pages8
JournalEuropean journal of preventive cardiology
Volume23
Issue number15
DOIs
Publication statusPublished - Oct-2016

Keywords

  • Athletes
  • coronary artery disease
  • coronary artery calcium score
  • coronary computed tomography angiography
  • exercise electrocardiography
  • screening
  • AMERICAN-HEART-ASSOCIATION
  • SCIENTIFIC STATEMENT
  • EXERCISE PHYSIOLOGY
  • GENERAL-POPULATION
  • RANDOMIZED-TRIALS
  • MARATHON RUNNERS
  • EUROPEAN-SOCIETY
  • STATIN THERAPY
  • CT ANGIOGRAPHY
  • CARDIAC-ARREST

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