Abstract

Although endurance exercise is cardioprotective, episodes of strenuous physical exertion can trigger sudden cardiac death. While marathon training promotes overall heart health, running such races transiently increases cardiac arrest risk, mainly in middle-aged men with subclinical coronary atherosclerosis. Coronary artery calcium scanning has been advised for risk stratification to identify those who benefit from enhanced primary prevention. Based on a 40% reduction in first heart attacks in same-aged men in the final report on aspirin in the Physicians Health Study, low-dose aspirin has been recommended for such runners and elderly persons at increased risk for sudden cardiac death during recreational sports activity. This approach may also provide primary prevention for patients with conditions such as human immunodeficiency virus infection in which inflammation promotes progressive coronary atherosclerosis. This strategy is supported by a 31% reduction in major acute cardiac events with the addition of low-dose aspirin to the polypill in persons with moderate risk factors. Evidence-based in two randomized, controlled clinical trials, low-dose aspirin guided by coronary artery calcium scoring for primary prevention warrants timely consideration, given the sharply increasing burden of atherosclerosis forecast until 2050 by the American Heart Association.

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