MY RESPONSE TO THE ALARM
THAT "RUNNING A MARATHON MAY PREDISPOSE TO HEART ATTACK"
FROM MY EXPERIENCE AS A STUDY PARTICIPANT IN THE ARTICLE CITED
From: Glenn Geelhoed
To: "MarcWWolfson@aol.com".IA4GW.Harper; Internet:mcrun@mcrrc.org
Date: 10/30/01 11:43AM
Subject: Re: Washington Post Health Section Article
Yes, Marc! We were both out, joining others in pounding the ground in Baltimore and Washington despite reports that there could be something inflammatory about running! Judging from previous notes from finishers of the 26th MCM, no one needed a specialized muscle enzyme laboratory to recognize this.
I know Art Siegel from Boston residency days well and I know the study even better, since my blood has run through it each of the years reported in the articles cited in the Post piece. We give blood before and after the Boston Marathon for a study of muscle enzymes which can leak from muscle cells during inflammatory stress, but only some of those muscle cells are in the myocardium. It would come as no surprise to any runner waking up with some muscle memory of the marathon the day before that there is some effect in skeletal muscle. Differentiating the source of the elevated muscle enzymes--often run on a patient with chest pain in the Emergency Room as an indicator of myocardial events--whether from skeletal or cardiac muscle is the clue the studies are seeking. Troponins and creatine kinase-MB are bands within the generally elevated enzymes that may correlate more with myocardial origin. These have been indeterminate.
This differentiation can help to keep a few of the runners each year who report chest pain after the marathon and on the basis of the broader spectrum muscle enzyme screen find themselves popped into a CCU bed for a day or so next to people they resemble very little.
C-reactive protein is a general indicator of inflammation, and is less correlated with heart attack than the likelihood of a Motrin packet in the runner's warm up pants pocket.
The cautious qualified conclusions of the reports and their editorial interpretation is "Be reasonable" in pursuing the healthy sport of endurance running--medical advice followed by runners about as religiously as the contrary advice to counterpart sofa spuds to get up and get moving!
It is also important to note that the elevated indicators were reported following each of the Boston marathon completions, but in this group of genteelly labeled "middle-age" physicians, no clinical events or cardiac damage was reported, with contrary evidence against cardiac disease, uncharacteristically low in prevalence in this risk group.
The inflammation markers are indicative, not determinative.
If worried, one (baby) aspirin should relieve the anxiety.
Happy Trails!
GWG