Master@Heart Study

Cardiovascular disease is the leading cause of death among Europeans and accounts for 29.6% of all deaths worldwide in 2014. Coronary heart disease (CAD), when considered separately, accounts for almost 1.8 million deaths, or 20% of all deaths in Europe annually. There has been a global increase in the incidence of CAD over the past 5 decades, due to the establishment of a sedentary lifestyle combined with inadequate dietary habits and the prevalence of smoking.

In parallel with this modern inactivity pandemic and its associated cardiovascular risks, the past 2 decades have also witnessed an increase in the number of middle‐aged and older individuals engaging in competitive sports and mass exercise events, such as marathon‐running and cycling events in the more economically developed countries. The health benefits of exercise, both on cardiovascular and non-cardiovascular mortality, have been widely established. Moderate-intensity aerobic exercise of at least 150 minutes per week has been shown to provide significant health effects with a 50% reduction in adverse cardiac events and reduced mortality.

However, studies of the upper ranges of the exercise dose-response relationship are limited. Retrospective observations provide some reassurance, but have been difficult to interpret given major differences between athletic and referent populations in cardiovascular risk factors such as smoking and socio-economic status. Endurance sports participation improves blood pressure control, lipid profiles and insulin sensitivity and therefore, not surprisingly, has been associated with a reduced incidence of myocardial infarction. This may explain the longer life expectancy of athletes as compared to the general population. On the other hand, there is increasing evidence suggesting that intense exercise, particularly intense endurance exercise, can be associated with adverse cardiac remodelling and an excess of arrhythmias. Thus, it is possible that it is healthy being an endurance athlete but not necessarily that the health benefit is derived from exercise itself, as opposed to all of the other favourable lifestyle factors.

Until present, no studies have compared the ‘standard of care,’ which includes a healthy diet, abstinence from smoking, and regular moderate exercise, with and without the addition of long-term endurance exercise. In this multicentre project we will investigate the beneficial effects of long-term endurance exercise for the prevention of coronary and carotid artery disease and its potential adverse effects, such as an increased incidence of atrial fibrillation and myocardial fibrosis. We will recruit 3 age-and gender-matched cross-sectional cohorts: (1) lifelong endurance athletes engaged in regular endurance sports practice since the age of 30 years, (2) late-onset endurance athletes participating in regular endurance sports activities at least 6 month and (3) non-athletic individuals. The late-onset endurance athletes will  have started regular endurance exercise after the age of 30, and therefore, will not have been exposed to the potential beneficial or adverse effects of long-term endurance exercise.


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