@article{Knechtle2026, 
author = {Beat Knechtle and Sasa Duric and Volker Scheer and Pantelis T. Nikolaidis and Daniela Chlíbková and Luciano Bernardes Leite and Ivan Cuk and Pedro Forte and Matthias Wilhelm and Katja Weiss and Thomas Rosemann},
title = {Resilience against exercise-related coronary atherosclerosis: A case study in a master athlete participating in 500 marathons},
year = {2026},
journal = {Sports Medicine and Health Science},
volume = {8},
number = {2},
pages = {219-227},
keywords = {Running, Middle-aged man, Cardiovascular disease},
url = {https://www.sciopen.com/article/10.1016/j.smhs.2025.07.011},
doi = {10.1016/j.smhs.2025.07.011},
abstract = {Background and purposeLifelong endurance exercise is generally associated with cardiovascular health benefits. However, recent studies suggest that prolonged high-volume training may contribute to coronary atherosclerosis, even in athletes with low traditional cardiovascular risk. This case report aims to explore the cardiovascular status of a master endurance athlete with an exceptionally high lifetime training volume, in light of recent concerns raised in the literature.MethodsWe present the case of a 60-year-old recreational male marathon runner with no history of cardiovascular disease, who completed over 500 marathons between the ages of 30 and 60 years, covering ~127000km running. In 2024 alone, he completed 60 marathons. Cardiovascular evaluation included clinical risk assessment and coronary computed tomography angiography (CTCA).ResultsThe runner was asymptomatic, had a low ESC-SCORE2 (3.3%), a favorable lipid profile, and normal levels of high-sensitivity C-reactive protein and lipoprotein (a). CTCA revealed no evidence of calcified, mixed, or non-calcified coronary plaques.ConclusionsThis case highlights that some master athletes may demonstrate resilience to coronary atherosclerosis despite decades of high training volume. In low-risk individuals, prolonged endurance training alone may not necessarily lead to coronary artery disease, emphasizing the need for individualized cardiovascular screening strategies.}
}