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

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SUMMARYBackgroundAn 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.InvestigationsConventional risk-factor assessment, coronary artery calcium quantification, bicycle stress test, echocardiography, coronary angiography, intravascular ultrasonography, including virtual histology, and intracoronary Doppler ultrasonography.DiagnosisSevere coronary atherosclerosis of the left anterior descending, mid left circumflex, and left main arteries.ManagementStenting of the left anterior descending artery, CABG surgery, and intensive risk-factor modification. The patient was also advised against participating in future marathon competitions.

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