Long distance running and the risk of Coronary Artery Plaque

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Long distance running and the risk of Coronary Artery Plaque

Postby Rick C » Thu Mar 27, 2014 12:50 pm

For the general interest of the group . . .

A couple of articles appearing yesterday in the Wall St. Journal and the Kansas City Star citing recent research talking about what years of long distance running might mean for an increased risk of Coronary Artery Plaque. Basically, they seem to be saying there is a sweet spot for mileage through the years and exceeding that consistently might put you in the same seat as someone lounging in an armchair that whole time.

http://online.wsj.com/news/articles/SB10001424052702303949704579461381883678174?mod=trending_now_2i

http://www.kansascity.com/2014/03/25/4916166/walk-away-from-excess-running.html
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Re: Long distance running and the risk of Coronary Artery Pl

Postby Nicholas » Thu Mar 27, 2014 2:43 pm

Yeah....well I was diagnosed with AFib (atrial fibrillation) in October. It is constant with no periods where the rhythm is "normal". No predisposition to it for any reason that they screen for (smoking, weight, family history etc.). They also found a potential for blockage during a follow-up stress test. So, I went for a nuclear stress test where they inject a nuclear dye into your blood, scan your heart, do the stress test on the TM and re-scan your heart. They say it could have been a false positive but I see the cardiologist tomorrow for the results. Having been a runner for decades and doing many half and full marathons, it is not nice to hear this warning now....it's too late.
I did do a scan of the topic (thanks to Mr. Google) and there are many studies like the ones in the original post, with many of them pointing to the development of AFib and artery problems in middle-aged endurance athletes who continued to exercise at a relatively high volume. However, there does not seem to be a consensus as to why it occurs. It is mostly prevalent in males.
Anyone else on the Forum experiencing these problems as they run into the sunset?

Here is another interesting link:
http://www.drjohnm.org/2012/11/cycling-wed-i-told-you-so/
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Re: Long distance running and the risk of Coronary Artery Pl

Postby Spirit Unleashed » Thu Mar 27, 2014 6:35 pm

This has been refuted but I'm not enough of a researcher to remember where the references might be. It is not new news anyway.
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Re: Long distance running and the risk of Coronary Artery Pl

Postby Rick C » Thu Mar 27, 2014 6:41 pm

Spirit wrote:This has been refuted but I'm not enough of a researcher to remember where the references might be. It is not new news anyway.


The articles are based on a study published a few days ago.

O’Keefe is co-author of the paper in the latest issue of Missouri Medicine, the journal of the Missouri State Medical Association. The study was conducted by Robert Schwartz and colleagues at the Minneapolis Heart Institute Foundation.

Read more here: http://www.kansascity.com/2014/03/25/49 ... rylink=cpy
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Re: Long distance running and the risk of Coronary Artery Pl

Postby Jwolf » Thu Mar 27, 2014 6:46 pm

It seems like there is so much conflicting evidence out there.
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Re: Long distance running and the risk of Coronary Artery Pl

Postby Spirit Unleashed » Thu Mar 27, 2014 6:47 pm

Rick C wrote:
Spirit wrote:This has been refuted but I'm not enough of a researcher to remember where the references might be. It is not new news anyway.


The articles are based on a study published a few days ago.

O’Keefe is co-author of the paper in the latest issue of Missouri Medicine, the journal of the Missouri State Medical Association. The study was conducted by Robert Schwartz and colleagues at the Minneapolis Heart Institute Foundation.

Read more here: http://www.kansascity.com/2014/03/25/49 ... rylink=cpy

right, but that doctor has been promoting this for a couple of years.
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Re: Long distance running and the risk of Coronary Artery Pl

Postby Nicholas » Thu Mar 27, 2014 7:37 pm

But there are other studies linking the performing of endurance activities over many years to heart problems. I looked specifically for links between marathon running and AFib and got hits such as this study:
http://www.medscape.com/viewarticle/586379_1

The earlier studies in this thread focus more on hardening and blockage of the arteries etc. I'd like to see this being proven wrong if someone has access to such data. It has been hammered into me for 35 years that the heart is a muscle and the more you push it, the stronger it becomes.
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Re: Long distance running and the risk of Coronary Artery Pl

Postby Spirit Unleashed » Thu Mar 27, 2014 9:12 pm

I suppose Dr Dee or Dr JW are better at that than me.
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Re: Long distance running and the risk of Coronary Artery Pl

Postby Jwolf » Thu Mar 27, 2014 9:40 pm

I couldn't read the paper that's linked in Nick's last post- it requires login access.

Medical research is not my field so I'm not sure I could critically analyze the paper anyway but it would be good to see it.
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Re: Long distance running and the risk of Coronary Artery Pl

Postby Nicholas » Thu Mar 27, 2014 9:45 pm

Jwolf wrote:I couldn't read the paper that's linked in Nick's last post- it requires login access.

Weird..I can just click on the link and go straight to the article. I have no login privileges to that site. Maybe it's like most of the studies and it's for males only???? :D
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Re: Long distance running and the risk of Coronary Artery Pl

Postby Dstew » Thu Mar 27, 2014 9:51 pm

Been to my doctor, first check up in years and got the same sort of warning. My doctor is very much like the one quoted in the article that here are your risks, you do with that information that you want. It makes perfect sense that as with everything else, there is a U curve: too much can be as bad as too little. The only question is for each individual, where does that too much kick in. The 20 - 25 miles per week figure does seem to consistent with the injury research that number is safe for just about anyone. And what is know about genetics, that number will have a wide variation. For some 25 mpw might be entering the red zone and for others, 50 - 70 mpw is something their body can handle. Given my size and physiology, my guess is I am at or close the 25 mpw group. For an Ian or Finger or Michael, that number is going to be significantly higher. I would be as bold as to speculate there are some that have a number they could never practically reach.

I think one very overlooked aspect of the study will be how bad the run to eat advice is. Although my doctor was a little concerned with my mileage, blood test results showed that my diet needed a radical change. When not running I was working out at least 30 minutes every day and currently, resistance training three times a week so that I could eat as many chocolate chip cookies as I wanted. To say the results are common sense is an understatement that you still have to eat healthy regards of the miles.

I have a damaged heart value and at a certain age, one comes to realize just how not invincible they are. That exercising alone is not the answer and there is too much. So after June , that is the last endurance event I will do. And if universe could be anymore direct, a 57 year old without any health problems and active died of a massive heart attack and was in the news as he was a beloved politician. There is an option other than die on the couch or die when running and that will be up to each individual to make that decision. For me, a 5' 11" 200 pound 50 year old with prior heart issues should not be running endurance events at a certain point and for me, I have reached that point. Some of the other born endurance runners due to genes, etc, may not zero reason to be concerned.

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Re: Long distance running and the risk of Coronary Artery Pl

Postby Jwolf » Thu Mar 27, 2014 9:59 pm

Nick wrote:
Jwolf wrote:I couldn't read the paper that's linked in Nick's last post- it requires login access.

Weird..I can just click on the link and go straight to the article. I have no login privileges to that site. Maybe it's like most of the studies and it's for males only???? :D


Hmmmm I just tried again and the link brings me to the login page ... But it says I can create a free account. I'll try tomorrow. :)
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Re: Long distance running and the risk of Coronary Artery Pl

Postby Jwolf » Thu Mar 27, 2014 10:00 pm

Nick wrote:
Jwolf wrote:I couldn't read the paper that's linked in Nick's last post- it requires login access.

Weird..I can just click on the link and go straight to the article. I have no login privileges to that site. Maybe it's like most of the studies and it's for males only???? :D


Hmmmm I just tried again and the link brings me to the login page ... But it says I can create a free account. I'll try tomorrow. :)
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Re: Long distance running and the risk of Coronary Artery Pl

Postby deerdree » Thu Mar 27, 2014 10:19 pm

Jwolf wrote:I couldn't read the paper that's linked in Nick's last post- it requires login access.

Medical research is not my field so I'm not sure I could critically analyze the paper anyway but it would be good to see it.

oh darn. medical research IS my field. but my brain is too tired tonight.

that said, i'm curious whether the evidence is really conflicting on this? we're seeing more and more research that says that running beyond a (yet-to-be-determined) point is detrimental - or at least not beneficial. but is there evidence out there that some running is good so lots must be better?

anecdotally, i just googled 'marathons are good for you' and the first hits that came back were:
"The Health Risks of the Marathon"
7 Surprising Dangers of Running a Marathon
26 Reasons Not To Run A Marathon
3 Reasons Why You Should Not Run A Marathon
The Severe Health Risks of Marathon Running
Negative Effects Of Running A Marathon

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Re: Long distance running and the risk of Coronary Artery Pl

Postby dgrant » Thu Mar 27, 2014 10:50 pm

Rick C wrote:For the general interest of the group . . .

A couple of articles appearing yesterday in the Wall St. Journal and the Kansas City Star citing recent research talking about what years of long distance running might mean for an increased risk of Coronary Artery Plaque. Basically, they seem to be saying there is a sweet spot for mileage through the years and exceeding that consistently might put you in the same seat as someone lounging in an armchair that whole time.

http://online.wsj.com/news/articles/SB10001424052702303949704579461381883678174?mod=trending_now_2i

http://www.kansascity.com/2014/03/25/4916166/walk-away-from-excess-running.html


Being in my late 30s with roughly 40,000 km of running behind me, I'd like to learn more about this. Hopefully it's not too late to adjust my activity for best health. However, the study cited doesn't seem very useful. Fifty people who have run a marathon a year for 25 years don't make for a very definitive group. Are they people who run 40km/wk or 140km/wk? Are they 20lbs underweight or 20lbs overweight? Apart from doing one similar activity on one day out of 365, do they have anything in common that really makes them a "group" for medical study?

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Re: Long distance running and the risk of Coronary Artery Pl

Postby deerdree » Thu Mar 27, 2014 11:17 pm

dgrant wrote:
Rick C wrote:For the general interest of the group . . .

A couple of articles appearing yesterday in the Wall St. Journal and the Kansas City Star citing recent research talking about what years of long distance running might mean for an increased risk of Coronary Artery Plaque. Basically, they seem to be saying there is a sweet spot for mileage through the years and exceeding that consistently might put you in the same seat as someone lounging in an armchair that whole time.

http://online.wsj.com/news/articles/SB10001424052702303949704579461381883678174?mod=trending_now_2i

http://www.kansascity.com/2014/03/25/4916166/walk-away-from-excess-running.html


Being in my late 30s with roughly 40,000 km of running behind me, I'd like to learn more about this. Hopefully it's not too late to adjust my activity for best health. However, the study cited doesn't seem very useful. Fifty people who have run a marathon a year for 25 years don't make for a very definitive group. Are they people who run 40km/wk or 140km/wk? Are they 20lbs underweight or 20lbs overweight? Apart from doing one similar activity on one day out of 365, do they have anything in common that really makes them a "group" for medical study?

maybe this study (with a bigger sample and over a long duration) would be more compelling? we've talked about this one on RM before:

"The Copenhagen City Heart Study followed 1,878 runners and 10,158 non-runners for up to 35 years. The runners had an impressive 44% lower risk of mortality during follow-up, with an increase in life expectancy of about six years for both genders. Importantly though, U-shaped curves were apparent for mortality with respect to dose of running, whereby the benefits of running were most significant for those who jogged between 1 to 2.5 hours per week, at a slow to moderate pace, with a frequency of about three times per week. In those runners who were performing higher volume, higher intensity running, the long-term mortality rates were not significantly different from non-runners. In other words, excessive running may have abolished the remarkable improvements in longevity conferred by lower doses of running."

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Re: Long distance running and the risk of Coronary Artery Pl

Postby kab » Fri Mar 28, 2014 6:05 am

I looked all over the place for this study that O'Keefe is referring to and it appears not to have been published in a peer reviewed journal. I would like to be able to read it before coming to any conclusions.
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Re: Long distance running and the risk of Coronary Artery Pl

Postby deerdree » Fri Mar 28, 2014 8:41 am

kab wrote:I looked all over the place for this study that O'Keefe is referring to and it appears not to have been published in a peer reviewed journal. I would like to be able to read it before coming to any conclusions.

http://www.msma.org/docs/communications ... dicine.pdf

eta: i wasn't sure at first because i'd never heard of it, but the journal is peer-reviewed:
"In publication since 1904, Missouri Medicine, a peer-reviewed, award-winning medical journal printed on acid-free paper, is indexed by MEDLINE, the National Library of Medicine, and is linked to PubMed Central, which is the U.S. National Institutes of Health digital archive of biomedical and life sciences journal literature. Missouri Medicine can be found on EBSCOhost databases, which provides researchers with the ability to search full-text articles, and are the most-used, premium online information resources for tens of thousands of institutions worldwide, representing millions of end-users. Missouri Medicine also provides featured content for www.medhelp.org, a top world health care website and the MedHelp.org e-newsletter, which has a quarter million subscribers."

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Re: Long distance running and the risk of Coronary Artery Pl

Postby Spirit Unleashed » Fri Mar 28, 2014 9:27 am

IMO (hate me if you want): most people would blame marathons before blaming BBQ and ice cream. Now I am going for a long walk jog.
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Re: Long distance running and the risk of Coronary Artery Pl

Postby dgrant » Fri Mar 28, 2014 9:41 am

deerdree wrote:
dgrant wrote:
Rick C wrote:For the general interest of the group . . .

A couple of articles appearing yesterday in the Wall St. Journal and the Kansas City Star citing recent research talking about what years of long distance running might mean for an increased risk of Coronary Artery Plaque. Basically, they seem to be saying there is a sweet spot for mileage through the years and exceeding that consistently might put you in the same seat as someone lounging in an armchair that whole time.

http://online.wsj.com/news/articles/SB10001424052702303949704579461381883678174?mod=trending_now_2i

http://www.kansascity.com/2014/03/25/4916166/walk-away-from-excess-running.html


Being in my late 30s with roughly 40,000 km of running behind me, I'd like to learn more about this. Hopefully it's not too late to adjust my activity for best health. However, the study cited doesn't seem very useful. Fifty people who have run a marathon a year for 25 years don't make for a very definitive group. Are they people who run 40km/wk or 140km/wk? Are they 20lbs underweight or 20lbs overweight? Apart from doing one similar activity on one day out of 365, do they have anything in common that really makes them a "group" for medical study?

maybe this study (with a bigger sample and over a long duration) would be more compelling? we've talked about this one on RM before:

"The Copenhagen City Heart Study followed 1,878 runners and 10,158 non-runners for up to 35 years. The runners had an impressive 44% lower risk of mortality during follow-up, with an increase in life expectancy of about six years for both genders. Importantly though, U-shaped curves were apparent for mortality with respect to dose of running, whereby the benefits of running were most significant for those who jogged between 1 to 2.5 hours per week, at a slow to moderate pace, with a frequency of about three times per week. In those runners who were performing higher volume, higher intensity running, the long-term mortality rates were not significantly different from non-runners. In other words, excessive running may have abolished the remarkable improvements in longevity conferred by lower doses of running."


That's interesting, thanks. Boy, 1 to 2.5hrs per week is a pretty low number for hobbyist runners.

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Re: Long distance running and the risk of Coronary Artery Pl

Postby Jwolf » Fri Mar 28, 2014 10:57 am

1-1.5 hours per week is even below the recommended minimum number of minutes of exercise (150 minutes) we talked about in the other thread. I know personally I get very little benefit from that low amount of exercise.
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Re: Long distance running and the risk of Coronary Artery Pl

Postby Rick C » Fri Mar 28, 2014 11:09 am

dgrant wrote:
Rick C wrote:For the general interest of the group . . .

A couple of articles appearing yesterday in the Wall St. Journal and the Kansas City Star citing recent research talking about what years of long distance running might mean for an increased risk of Coronary Artery Plaque. Basically, they seem to be saying there is a sweet spot for mileage through the years and exceeding that consistently might put you in the same seat as someone lounging in an armchair that whole time.

http://online.wsj.com/news/articles/SB10001424052702303949704579461381883678174?mod=trending_now_2i

http://www.kansascity.com/2014/03/25/4916166/walk-away-from-excess-running.html


Being in my late 30s with roughly 40,000 km of running behind me, I'd like to learn more about this. Hopefully it's not too late to adjust my activity for best health. However, the study cited doesn't seem very useful. Fifty people who have run a marathon a year for 25 years don't make for a very definitive group. Are they people who run 40km/wk or 140km/wk? Are they 20lbs underweight or 20lbs overweight? Apart from doing one similar activity on one day out of 365, do they have anything in common that really makes them a "group" for medical study?


The author of the Missouri study indicated in the Kansas City Star article that 15-20 miles a week (up to 32 KM) seems to be the sweet spot for optimum benefits from running, give or take your personal circumstances. His words, not mine. If you're running a moderate pace, that's about two or three hours of running per week.

That's probably the norm to train for a fairly decent half marathon result but probably not enough for a competent full marathon. The half marathon distance is the most popular in North America, passing the 10 km distance a few years ago. About 60% of those who completed a half marathon last year hadn't run the distance as recently as 2009. About 60% of finishers in a half marathon are female. About 60% of finishers in a marathon are male.

The Wall St. Journal article quoted this Feb. 2014 British Medical Journal study where subject Boston Marathon finishers were compared to their spouses under the assumption both subjects had roughly the same diet and comparable circumstances.: http://bmjopen.bmj.com/content/4/2/e004498.full . Conclusions: Habitual endurance exercise improves the cardiovascular risk profile, but does not reduce the magnitude of carotid atherosclerosis associated with age and cardiovascular risk factors.. Basically, the Boston Marathon finishers - a bit of an elite race because of the qualifying standards - used in the study were at the same risk of heart disease as their sedentary spouses. No benefit in that regard from marathon running.

I'm 55 and have been running for about 30 years - the 15-20 miles per week number (max 32 KM per week) is probably what I've been doing out of habit for the last 15 years or so. I did a 1:49 half marathon last Fall. If I'm ramping up for an infrequent marathon, the total mileage gets into the 45 to 60 km per week area but I won't hold it there as a matter of routine through the year. I'm running differently in the last few years, more frequent, shorter, higher tempo runs or sprints and throwing in longer weekly runs at a slower pace. Total mileage has become less important than quality of the mileage. This seems to serve my lazy ass mentality and older physiology fairly well and, surprisingly, I'm generally getting faster (last weekend's half marathon disaster aside) than I've been in a long while. It's also more interesting and, even though I'm still terrible at marathons, I'm getting less terrible.

So, the author of the Missouri study is telling me something I want to hear - that 25-32 km a week is a sweet number for optimum, long-term benefit. If you're a committed marathoner and ultra-runner, however, he's definitely annoying you.
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Re: Long distance running and the risk of Coronary Artery Pl

Postby Avis » Fri Mar 28, 2014 11:22 am

Boy, I hope I'm not at the other end of the U-curve--the one that even less than 25 k per week could find damaging. I started running after age 50, and have a family tree filled with heart disease. My cardiologist has given me the green light for running, saying I can do as much as I want. However, he knows I'm still `way under 25 miles a week.

One thing no one's mentioned here is a consideration of the pace at which the running that is done. A very slow jog is a different way of spending an hour running than doing a hard tempo or intervals.
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Re: Long distance running and the risk of Coronary Artery Pl

Postby deerdree » Fri Mar 28, 2014 11:30 am

Jwolf wrote:1-1.5 hours per week is even below the recommended minimum number of minutes of exercise (150 minutes) we talked about in the other thread. I know personally I get very little benefit from that low amount of exercise.

it does seem low. as rick c said, the number from another study put the tipping point higher:

"Highly significant mortality reductions were seen in the runners compared to the non-runners, but U-shaped curves again showed that the lowest mortality rates were seen in those running 5 to 20 miles/ week, and that the longevity benefits of running completely disappeared with distances greater than 25 to 30 miles/ week. Still, the mortality rates in the high mileage runners were similar to but did not exceed those for sedentary individuals)."

so, moderate running > "excessive" running > non-running.

that being said, the people i know who aren't "runners" but run as part of a general toolkit of fitness don't tend to run more than 1.5 hours/week. enough to knock out a 5k about 3 times/week, but they do other things like strength training, yoga, etc. i think the bias on RM is that a lot of people really like running, so they would choose it to the exclusion of other types of exercise. but i don't think the authors are suggesting that you exercise for 1.5 hours/week, total. i wonder if there are similar studies out there on the effect of other high-intensity exercise?

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Re: Long distance running and the risk of Coronary Artery Pl

Postby Spirit Unleashed » Fri Mar 28, 2014 12:38 pm

Yoni Friedhoff blogged about an article that said that sedentary people who exercise an hour a day are not different than sedentary people who didn't exercise.
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