On the paradox of exercise: coronary atherosclerosis in an apparently healthy marathon runner.

BACKGROUND: An asymptomatic and apparently healthy 64-year-old marathon runner underwent comprehensive cardiovascular risk assessment as part of a prospective study on calcified coronary plaque burden in master marathon runners. His profile suggested a low 10-year cardiovascular risk. INVESTIGATIONS: Conventional risk-factor assessment, coronary artery calcium quantification, bicycle stress test, echocardiography, coronary angiography, intravascular ultrasonography, including virtual histology, and intracoronary Doppler ultrasonography. DIAGNOSIS: Severe coronary atherosclerosis of the left anterior descending, mid left circumflex, and left main arteries. MANAGEMENT: Stenting of the left anterior descending artery, CABG surgery, and intensive risk-factor modification. The patient was also advised against participating in future marathon competitions.