News | Cardiac Diagnostics | January 09, 2018

Male Triathletes May Be Putting Their Heart Health at Risk

Athletes with longer cycling and swimming distances, coupled with higher peak exercise systolic blood pressure, are at higher risk of myocardial fibrosis. 

Male Triathletes May Be Putting Their Heart Health at Risk

January 9, 2018 – Competitive male triathletes face a higher risk of a potentially harmful heart condition called myocardial fibrosis, according to research presented at the annual meeting of the Radiological Society of North America (RSNA),  Nov. 26-Dec. 1 in Chicago. The increased risk, which was not evident in female triathletes, was directly associated with the athletes’ amount of exercise.

Myocardial fibrosis is scarring of the heart usually affecting the ventricles. The condition might progress to heart failure. While regular exercise has beneficial effects on the cardiovascular system, previous studies have shown the presence of myocardial fibrosis in elite athletes.

“The clinical relevance of these scars is currently unclear,” said study lead author Jitka Starekova, M.D., fellow in the Department for Diagnostic and Interventional Radiology and Nuclear Medicine at University Medical Center Hamburg-Eppendorf in Hamburg, Germany. “However, they might be a foundation for future heart failure and arrhythmia.”

Starekova and colleagues recently studied a group of triathletes, including 55 men, average age 44, and 30 women, average age 43. The study group underwent cardiac magnetic resonance imaging (MRI) exams with the contrast agent gadolinium, which is taken up by both normal and injured heart muscle tissue. Gadolinium washes out quickly in normal heart tissue, but much more slowly in scarred tissue, revealing a difference in contrast between normal and injured heart muscle after approximately 10 minutes. This phenomenon, known as late gadolinium enhancement, is a useful tool for detection of myocardial fibrosis.

Evidence of myocardial fibrosis was apparent in the left ventricle in 10 of 55 of the men, or 18 percent, but in none of the women.

These same athletes had completed significantly longer total swimming and cycling distances and had higher peak exercise systolic blood pressure than their counterparts without myocardial fibrosis.

Lifetime competition history for the athletes showed that the number of completed Iron Man triathlons and the number of middle distance triathlons were significantly higher in the male triathlete population compared to the female triathlete population, suggesting that the fibrosis risk was likely associated with exercise level.

“Comparison of the exercise test results revealed that female triathletes had lower systolic blood pressure at peak exercise and achieved lower maximal power compared to male triathletes,” Starekova noted. “Furthermore, comparison of the sport history showed that females had a tendency to complete shorter distances compared to male triathletes. This supports the concept that blood pressure and race distances could have an impact on formation of myocardial fibrosis.”

There are several possible factors for the link between the amount of exercise and the risk of myocardial fibrosis, according to Starekova. Higher exercise-induced systolic blood pressure may result in greater myocardial mass, she said, and more exercise might expose the athlete to a higher risk of myocarditis, or inflammation of the heart muscle. These factors, in combination with repeatedly increased stress of the left ventricular wall due to exercise, could injure the heart muscle.

Other factors may be responsible for the striking difference in myocardial fibrosis risk between male and female triathletes, Starekova said, including the presence of testosterone.

“Although we cannot prove the exact mechanism for the development of myocardial fibrosis in triathletes, increased systolic blood pressure during exercise, the amount and extent of race distances and unnoticed myocarditis could be cofactors in the genesis of the condition,” she said. “In other words, repetition of any extreme athletic activity may not be beneficial for everyone.”

The researchers plan long-term follow-up studies to see if any cardiac events occur in the triathletes who had evidence of myocardial fibrosis.

Co-authors are Enver Tahir, M.D., Kai Muellerleile, M.D., Alexandra von Stritzky, M.D., Julia Muench, M.D., Maxim Avanesov, M.D., Julius Weinrich, M.D., Christian Stehning, Sebastian Bohnen, M.D., Ulf K. Radunski, M.D., Eric Freiwald, M.D., Stefan Blankenberg, M.D., Gerhard Adam, M.D., Axel Pressler, M.D., Monica Patten, M.D., and Gunnar K. Lund, M.D.

For more information: www.rsna.org

Related Content

Weight Loss Drug Does Not Increase Cardiovascular Events
News | Cardiac Diagnostics | August 31, 2018
A weight loss drug does not increase cardiovascular events, according to late breaking results from the CAMELLIA-TIMI...
Acarix Presents CADScor System at ESC 2018
News | Cardiac Diagnostics | August 27, 2018
Acarix AB’s ultra-sensitive acoustic CADScor System for coronary artery disease risk assessment will be on display at...
NIH Ending Funding for Moderate Alcohol and Cardiovascular Health Trial
News | Cardiac Diagnostics | August 24, 2018
The National Institutes of Health announced in June it plans to end funding to the Moderate Alcohol and Cardiovascular...
Study Shows Multiple Benefits of Patient-to-Patient Connectivity in Familial Chylomicronemia Syndrome
News | Cardiac Diagnostics | August 07, 2018
Akcea Therapeutics Inc., an affiliate of Ionis Pharmaceuticals Inc., announced the publication of results from the...
Being Overweight May Change Young Adults' Heart Structure, Function
News | Cardiac Diagnostics | August 03, 2018
Even as a young adult, being overweight may cause higher blood pressure and thicken heart muscle, setting the stage for...
High Intensity Exercise in Teenagers Could Ward Off Heart Disease

Ultrasound image of the carotid artery. Lines in yellow were used to determine arterial diameter and stretching before and following exercise.

News | Cardiac Diagnostics | July 16, 2018
New research published in Experimental Physiology has indicated potential differences in heart health benefits of...
News | Cardiac Diagnostics | June 14, 2018
A team of researchers says it has linked sensitivity to an allergen in red meat to the buildup of plaque in the...
The blood of patients with familial chylomicronemia syndrome (FCS) can appear milky in color (lipemic) due to the buildup of fat in their body. Image courtesy of Akcea Therapeutics.

The blood of patients with familial chylomicronemia syndrome (FCS) can appear milky in color (lipemic) due to the buildup of fat in their body. Image courtesy of Akcea Therapeutics.

 

Feature | Cardiac Diagnostics | May 07, 2018 | Steven D. Freedman, M.D., Ph.D.
 
Overlay Init