Amateur endurance runners demonstrate heterogeneous cardiovascular profiles, with a substantial burden of dyslipidaemia and a notable prevalence of exercise-induced arrhythmias in both groups.
Observational (n=72)
No
Amateur endurance runners, despite high fitness levels, have a substantial burden of cardiovascular risk factors like dyslipidemia and exercise-induced arrhythmias, highlighting the need for structured cardiovascular assessment.
Abstract Background/Introduction Participation in endurance sports has grown steadily, with marathon and ultramarathon runners presenting unique cardiovascular profiles in which high training loads coexist with age-related comorbidities. Understanding these interactions is essential to ensure safe sports participation and adequate cardiovascular risk stratification. Purpose To describe the cardiovascular characteristics, comorbidity burden and functional performance of amateur marathon and ultramarathon athletes evaluated at a sports cardiology reference center. Methods This retrospective observational registry included 72 amateur endurance runners assessed between 2024 and 2025. Data extracted from electronic medical records included demographics, comorbidities, echocardiographic parameters, coronary artery calcium scoring, and treadmill exercise testing. Athletes were stratified into marathon and ultramarathon groups for descriptive comparison. Results Among the cohort, 49 (68%) were marathoners (mean age 60; 61% male) and 23 (32%) ultramarathoners (mean age 57; 83% male). Marathoners showed 12% high cardiovascular risk and preserved left ventricular ejection fraction (≥50%) in 71%. Comorbidities included 16% hypertension, 2% diabetes, 8% coronary artery disease, 14% smoking history and 49% dyslipidaemia. Coronary calcium scoring was available in 9 athletes, with a mean of 21.6 Agatston units after excluding two pronounced outliers. Mean peak functional capacity on treadmill testing was 17.8 METs. Exercise-induced arrhythmias occurred in 20% (supraventricular) and 20% (ventricular), and one case of myocardial bridging was identified. In the ultramarathon group, all athletes had preserved ejection fraction. Comorbidities included 13% hypertension, 13% smoking history and 35% dyslipidaemia. No cases of diabetes or coronary disease were observed. Coronary calcium scoring was performed in 48% of athletes (mean 9 Agatston units; zero in six). Functional capacity was higher, with a mean of 19.2 METs. Exercise-induced arrhythmias occurred in 17% (supraventricular) and 4% (ventricular), and one athlete was diagnosed with non-obstructive hypertrophic cardiomyopathy. Conclusion Endurance runners demonstrate heterogeneous cardiovascular profiles despite high levels of fitness. A substantial burden of dyslipidaemia and a notable prevalence of exercise-induced arrhythmias were observed in both groups. These findings reinforce the importance of structured cardiovascular assessment in high-volume athletes, even when asymptomatic. Exercise remains essential for health, but intensive training does not replace comprehensive cardiovascular risk evaluation.Marathon Runners vs. Ultramarathon RunneFor image description, please refer to the figure legend and surrounding text.
Nascimento et al. (Mon,) conducted a observational in Amateur endurance runners (n=72). Ultramarathon running vs. Marathon running was evaluated on Cardiovascular characteristics, comorbidity burden and functional performance. Amateur endurance runners demonstrate heterogeneous cardiovascular profiles, with a substantial burden of dyslipidaemia and a notable prevalence of exercise-induced arrhythmias in both groups.