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<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_3248"
                     title="Increased Cardiac Events Seen With Sibutramine (CME/CE)"
                     score="0.015"
                     href="http://www.medpagetoday.com/Cardiology/MyocardialInfarction/tb/22008?impressionId=1283457941608"
                     
      &lt;p&gt;Overweight patients with cardiovascular risks who took the weight-loss drug sibutramine (Meridia) had a 16% increased likelihood of experiencing a cardiac event, a large randomized trial found.&lt;/p&gt;
&lt;p&gt;The overall hazard ratio for a fatal or nonfatal cardiovascular event was 1.16 (95% CI 1.03 to 1.31, &lt;em&gt;P&lt;/em&gt;=0.02) among patients receiving sibutramine compared with those receiving placebo, according to W. Philip T. James, MD, of the London School of Hygiene and Tropical Medicine, and colleagues.&lt;/p&gt;
&lt;p&gt;Specifically, the hazard ratio for nonfatal myocardial infarction was 1.28 (95% CI 1.04 to 1.57, &lt;em&gt;P&lt;/em&gt;=0.02), and the hazard ratio for nonfatal stroke was 1.36 (95% CI 1.04 to 1.77, &lt;em&gt;P&lt;/em&gt;=0.03), the researchers reported in the Sept. 1 &lt;em&gt;New England Journal of Medicine&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;A &lt;a href=&quot;http://www.medpagetoday.com/ProductAlert/Prescriptions/17147&quot; mce_href=&quot;http://www.medpagetoday.com/ProductAlert/Prescriptions/17147&quot; target=&quot;_blank&quot;&gt;preliminary analysis&lt;/a&gt;&lt;a target=&quot;_blank&quot;&gt; &lt;/a&gt;of data from the SCOUT (Sibutramine Cardiovascular Outcomes) trial previously suggested this increased risk, and the FDA required stronger &lt;a href=&quot;http://www.medpagetoday.com/ProductAlert/DevicesandVaccines/18088&quot; mce_href=&quot;http://www.medpagetoday.com/ProductAlert/DevicesandVaccines/18088&quot; target=&quot;_blank&quot;&gt;cautionary language&lt;/a&gt; in the drug&apos;s labeling.&lt;/p&gt;
&lt;p&gt;The final publication has now confirmed it, with James and colleagues stating, &quot;On the basis of these results, sibutramine should continue to be excluded from use in patients with preexisting cardiovascular disease.&quot;&lt;/p&gt;
&lt;p&gt;Sibutramine is a norepinephrine and serotonin reuptake inhibitor that has sympathomimetic effects and therefore can increase blood pressure and pulse rate. Because even small increases in blood pressure and pulse rate are associated with an increased likelihood of cardiovascular events, the SCOUT investigators wanted to determine the drug&apos;s long-term cardiovascular risk.&lt;/p&gt;
&lt;p&gt;They enrolled 9,804 obese or overweight patients who were at least 55 years old. All participants had a history of cardiovascular disease and/or type 2 diabetes.&lt;/p&gt;
&lt;p&gt;The study consisted of a six-week lead-in period in which all patients received 10 mg/day of sibutramine, after which they were randomized to the active treatment or placebo.&lt;/p&gt;
&lt;p&gt;Mean duration of treatment was 3.4 years, and slightly more than 40% of patients in both groups discontinued treatment.&lt;/p&gt;
&lt;p&gt;All patients also participated in individualized diet and exercise programs designed for cardioprotection, and blood pressure decreased in both groups during the lead-in phase.&lt;/p&gt;
&lt;p&gt;However, after randomization the sibutramine group had small but consistent increases in blood pressure and resting pulse rate.&lt;/p&gt;
&lt;p&gt;While there were increases in the nonfatal events, there was no between-group difference for cardiovascular death (HR 0.99, 95% CI 0.82 to 1.19, &lt;em&gt;P&lt;/em&gt;=0.90) or death from any cause (HR 1.04, 95% CI 0.91 to 1.20, &lt;em&gt;P&lt;/em&gt;=0.54).&lt;/p&gt;
&lt;p&gt;The investigators noted that fewer than half of the events they had expected at the outset of the trial occurred during its six-year overall duration, and that during that time the incidence of cardiovascular disease decreased in most of Europe and Australia, where most of the study centers were located.&lt;/p&gt;
&lt;p&gt;They also pointed out that the study was limited by the lack of a true placebo group, the inclusion of only high-risk patients, and the longer-than-recommended time of treatment (one to two years).&lt;/p&gt;
&lt;p&gt;In an accompanying editorial, Gregory D. Curfman, MD, executive editor of &lt;em&gt;NEJM, &lt;/em&gt;and colleagues commented that the cardiovascular risk findings of SCOUT need to be considered in light of the potential clinical benefit of the weight loss seen among those on sibutramine.&lt;/p&gt;
&lt;p&gt;Patients on the drug lost 4.3 kg at one year, but regained about 0.5 kg thereafter, for a net loss of less than 4 kg from a baseline average weight of 96 kg.&lt;/p&gt;
&lt;p&gt;In January 2010, after the preliminary analysis of the SCOUT data, the European Medicines Agency suspended marketing authorizations for sibutramine-containing medications throughout the European Union.&lt;/p&gt;
&lt;p&gt;On Sept. 15, an advisory committee of the FDA plans to meet to decide whether additional regulatory action should be taken here as well.&lt;/p&gt;
&lt;p&gt;Curfman and colleagues concluded, &quot;Given that sibutramine has minimal efficacy for weight loss, no apparent benefit for clinical outcomes, a worrisome cardiovascular risk profile, and a plausible mechanism to explain the cardiovascular risk, it is difficult to discern a credible rationale for keeping this medication on the market.&quot;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was funded by Abbott Laboratories.&lt;/p&gt;&lt;p&gt;Several of the SCOUT investigators reported serving on advisory boards and receiving fees from multiple pharmaceutical companies, including Abbott, sanofi-aventis, Merck, Johnson &amp;amp; Johnson, Novo Nordisk, GlaxoSmithKline, and Boehringer Ingelheim.&lt;/p&gt;&lt;p&gt;In addition, three of the investigtors were full-time employees of Abbott and had equity interest in the company.&lt;/p&gt;&lt;p&gt;Aside from Curfman&apos;s position with &lt;em&gt;NEJM&lt;/em&gt;, the editorialists had no disclosures.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_3206"
                     title="ESC: Genetic Testing for Clopidogrel May Not Help"
                     score="0.014"
                     href="http://www.medpagetoday.com/MeetingCoverage/ESCCongress/tb/21956?impressionId=1283457941608"
                     
      &lt;p&gt;STOCKHOLM  --  The future of genetic testing to identify poor metabolizers of clopidogrel (Plavix) remains foggy after presentation of multiple substudies of randomized controlled trials here.&lt;/p&gt;
&lt;p&gt;One study, an analysis of the CURE trial, showed that presence of one of two alleles associated with poorer metabolism of clopidogrel  --  *2 or *3 on the &lt;em&gt;CYP2C19&lt;/em&gt; gene  --  did not predict the occurrence of cardiovascular events among patients with non-ST-elevation acute coronary syndromes.&lt;/p&gt;
&lt;p&gt;An analysis of the PLATO trial, however, found that the presence of loss-of-function alleles predicted an increase in adverse cardiovascular events in the first 30 days  --  but not after  --  among patients with acute coronary syndromes with or without ST-segment elevation.&lt;/p&gt;
&lt;p&gt;Both were presented at the European Society of Cardiology Congress.&lt;/p&gt;
&lt;p&gt;A third analysis  --  of the TRITON-TIMI 38 trial  --  was published in &lt;em&gt;The Lancet&lt;/em&gt; to coincide with the meeting. It showed that, among patients with acute coronary syndromes undergoing percutaneous coronary intervention, presence of loss-of-function alleles was associated with increased adverse cardiovascular events in the clopidogrel group, but not in the prasugrel (Effient) group.&lt;/p&gt;
&lt;p&gt;The findings were met with a common refrain from cardiologists  --  the need for more studies to determine whether genetic testing actually matters in the care of patients.&lt;/p&gt;
&lt;p&gt;&quot;At the moment, we don&apos;t have hard evidence that we should be testing everyone for these genotypes,&quot; Roxana Mehran, MD, an interventional cardiologist at Columbia University Medical Center in New York City, told &lt;em&gt;MedPage Today&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;The FDA felt there was enough of a concern about these loss-of-function alleles to add a boxed warning on clopidogrel&apos;s label. The warning does not make a strong recommendation for genetic testing, or suggest a treatment approach for patients who carry the variants.&lt;/p&gt;
&lt;p&gt;Since the warning was added, cardiologists have been slow to adopt genetic testing in the face of a dearth of evidence showing that it matters in the management of patients.&lt;/p&gt;
&lt;p&gt;&quot;When that happens, it&apos;s a big deal,&quot; said R. Scott Wright, MD, a cardiologist at the Mayo Clinic in Rochester, Minn., referring to the addition of the boxed warning. But he added that physicians are largely not well-informed on this topic.&lt;/p&gt;
&lt;p&gt;Wright said that the Mayo Clinic is not regularly testing patients for the genetic variations and that he is waiting for trials to evaluate whether changing therapy on the basis of genetics will improve outcomes.&lt;/p&gt;
&lt;p&gt;He pointed toward a clinical alert released in June by the American College of Cardiology (ACC) and the American Heart Association (AHA) regarding the issue, which struck a similar chord.&lt;/p&gt;
&lt;p&gt;The writing committee, chaired by David Holmes, MD, also of the Mayo Clinic, noted that the &lt;em&gt;CYP2C19&lt;/em&gt; polymorphisms account for only 12% of the variability in platelet response with clopidogrel.&lt;/p&gt;
&lt;p&gt;Citing the lack of studies showing the effectiveness of personalizing antiplatelet therapy on the basis of genetic testing, the ACC and AHA did not recommend routine testing.&lt;/p&gt;
&lt;p&gt;&quot;Everybody would like to think that personalized medicine is going to be perfect,&quot; Holmes said at the ESC meeting. &quot;We just don&apos;t have chapter and verse to make sure that that&apos;s the case.&quot;&lt;/p&gt;
&lt;p&gt;He said there are some unresolved issues, including the fact that most patients do well with a stent without genetic testing, and the lack of a point-of-care genetic test that could potentially help physicians choose the appropriate antiplatelet in the acute phase after an MI, when it would be most important.&lt;/p&gt;
&lt;p&gt;Patients that might be good candidates for genetic testing are those who had stent thrombosis while taking clopidogrel, according to Holmes, although he said one might just switch to one of the new P2Y12 inhibitors with greater platelet inhibition  --  prasugrel or ticagrelor, if it is ultimately approved. Those two drugs have not been found to be affected by the &lt;em&gt;CYP2C19&lt;/em&gt; polymorphisms.&lt;/p&gt;
&lt;p&gt;&quot;The whole field is in flux,&quot; he said.&lt;/p&gt;
&lt;p&gt;So what can be learned from the different findings of the various subanalyses  --  that the genetics do not seem to matter in a chronic acute coronary syndrome population but may be more important in a more acute setting?&lt;/p&gt;
&lt;p&gt;Mehran said consideration of the the different patient populations in the CURE, PLATO, and TRITON-TIMI 38 studies is key.&lt;/p&gt;
&lt;p&gt;CURE was conducted at a time when PCI was not common, and only 18% of patients underwent PCI. In PLATO, 64% of the patients received a stent, and in TRITON-TIMI 38 close to 100% received a stent.&lt;/p&gt;
&lt;p&gt;&quot;So perhaps what we&apos;re left with is that genotype may matter in the acute phase, when there&apos;s a high rate of PCI,&quot; Rob Califf, MD, vice chancellor for research at Duke University, said in comments following the presentation of the CURE analysis.&lt;/p&gt;
&lt;p&gt;But the information from those subanalyses isn&apos;t going to help physicians treating patients now, Mehran said.&lt;/p&gt;
&lt;p&gt;&quot;[Physicians are] more confused now than they&apos;ve ever been before,&quot; said Mehran, pointing to the boxed warning for clopidogrel and the new findings. &quot;We need more clinical trials.&quot;&lt;/p&gt;
&lt;p&gt;In the meantime, she said physicians feel compelled to test for the genetic polymorphisms  --  as well as the platelet inhibition response to clopidogrel and aspirin  --  in patients who have had a cardiovascular event while taking clopidogrel.&lt;/p&gt;
&lt;p&gt;Gilles Montalescot, MD, PhD, an interventional cardiologist at Pitie&amp;#769;-Salpe&amp;#770;trie&amp;#768;re University Hospital in Paris, acknowledged that definitive recommendations regarding the need to use genetic testing to tailor antiplatelet treatment await randomized trials, but he thinks studies will ultimately support the need for it and show it to be superior or complementary to platelet function testing.&lt;/p&gt;
&lt;p&gt;&quot;This will be a win [for genetic testing], and I&apos;m sure it will be recommended in the guidelines,&quot; he said during a press briefing. &quot;Basic scientific information evolves so rapidly, but clinical trials ... it takes years to get the answers. So we have to be patient.&quot;&lt;/p&gt;
&lt;p&gt;Ideally, he added, a single test would be able to provide the information on genetics and platelet function.&lt;/p&gt;
&lt;p&gt;Clyde Yancy, MD, medical director of the Baylor Heart and Vascular Institute in Dallas, advised caution surrounding genetic testing for response to clopidogrel because of the incomplete knowledge of all relevant genetic markers.&lt;/p&gt;
&lt;p&gt;&quot;We have to continue to exercise a pretty significant amount of care and caution before we allow a genetic test per se to become the standard by which a drug is prescribed or a decision is made to prescribe a different drug,&quot; said Yancy, who is immediate past president of the AHA.&lt;/p&gt;
&lt;p&gt;A genetic test would be most useful if it definitively identified a group of patients who would not respond to a medication and in whom it would be inappropriate to prescribe it, he said, adding that he doesn&apos;t think the precision is there for the &lt;em&gt;CYP2C19&lt;/em&gt; polymorphisms and response to clopidogrel.&lt;/p&gt;
&lt;p&gt;&quot;So we have to be very careful extrapolating our enthusiasm for the science into the clinical arena.&quot;&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_3197"
                     title="ESC: No Blockbusters in Day One Hot Line Trials"
                     score="0.014"
                     href="http://www.medpagetoday.com/MeetingCoverage/ESCCongress/tb/21934?impressionId=1283457941608"
                     
      &lt;p&gt;STOCKHOLM  --  In this &lt;em&gt;MedPage Today&lt;/em&gt; exclusive InFocus video report, the president of the American Heart Association takes the temperature of the first group of Hot Line trials reported here at the European Society of Cardiology congress.&lt;/p&gt;
&lt;p&gt;Ralph L. Sacco, MD, MS, of the University of Miami, said the ALPHA-OMEGA trial  --  which found that fortifying margarine with omega-3 fatty acids derived from fish and plants was not an effective secondary prevention strategy  --  will probably not dampen enthusiasm for supplements. Sacco added that &quot;the whole fish&quot; approach is still a better way to include omega-3s in a heart-healthy diet. And, while the data on genetic testing to identify &quot;nonresponders&quot; to clopidogrel were interesting, he said they were not persuasive. Finally, Sacco told Peggy Peck, &lt;em&gt;MedPage Today &lt;/em&gt;executive editor, that a trial of intracoronary transplantation of bone marrow cells provided promising data that were still a long way from mainstream medicine.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_3211"
                     title="ESC: New Guidelines Are a Step Ahead of Regulators (CME/CE)"
                     score="0.014"
                     href="http://www.medpagetoday.com/MeetingCoverage/ESCCongress/tb/21962?impressionId=1283457941608"
                     
      &lt;p&gt;STOCKHOLM  --  The latest European Society of Cardiology guidelines for revascularization in myocardial infarction patients recommend the use of ticagrelor (Brilinta)  --  an antiplatelet agent that has not yet been approved by any regulatory agency  --  as a recommended antithrombotic treatment.&lt;/p&gt;
&lt;p&gt;The new guidelines, released at the ESC meeting here, listed ticagrelor with a Class 1, Evidence Level B recommendation  --  meaning that the recommendation is supported by evidence from a large clinical trial or from large nonrandomized studies, and there is general agreement that the treatment is &quot;beneficial, useful, effective.&quot;&lt;/p&gt;
&lt;p&gt;This is the same level of evidence given to clopidogrel (Plavix).&lt;/p&gt;
&lt;p&gt;Prasugrel (Effient) received a Class IIa Evidence Level B recommendation, meaning that the &quot;weight of the evidence or opinion is in favor of the usefulness or efficacy of the treatment.&quot;&lt;/p&gt;
&lt;p&gt;Sidney C. Smith, Jr., MD, of the University of North Carolina at Chapel Hill, said the inclusion of ticagrelor struck him as reasonable since the PLATO trial, reported at the &lt;a href=&quot;http://www.medpagetoday.com/MeetingCoverage/ESCCongress/15752&quot; mce_href=&quot;http://www.medpagetoday.com/MeetingCoverage/ESCCongress/15752&quot; target=&quot;_blank&quot;&gt;ESC a year ago&lt;/a&gt;, found that the drug, a non-thienopyridine ADP receptor blocker, was significantly superior to clopidogrel in reducing cardiovascular events  --  including cardiovascular mortality.&lt;/p&gt;
&lt;p&gt;Guidelines, Smith emphasized, are about &quot;evidence, not politics.&quot;&lt;/p&gt;
&lt;p&gt;The inclusion of ticagrelor in the new guidelines did, however, give pause to other cardiologists at the ESC meeting.&lt;/p&gt;
&lt;p&gt;Ralph Brindis, MD, president of the American College of Cardiology, said that the inclusion of any unapproved drug in guidelines for clinicians was, to him, counterintuitive.&lt;/p&gt;
&lt;p&gt;&quot;I understand that one of the challenges [for guidelines committees] is to be as current as possible, but at the same time guidelines have to relevant to the practicing physician,&quot; Brindis said.&lt;/p&gt;
&lt;p&gt;Including a drug that is not clinically available &quot;does not make sense to the practicing clinician,&quot; he added.&lt;/p&gt;
&lt;p&gt;Brindis is an interventional cardiologist and from that perspective, he said that he understands the anticipation surrounding the eventual approval of ticagrelor.&lt;/p&gt;
&lt;p&gt;European regulators are expected to make a decision on ticagrelor in the next week or so, and the FDA is expected to issue its decision on the drug by mid-September  --  so the ESC may be ahead of the curve by including ticagrelor at this point.&lt;/p&gt;
&lt;p&gt;But regulators don&apos;t always make the expected decisions  --  so there is no guarantee until an official announcement is made.&lt;/p&gt;
&lt;p&gt;And even with the odds favoring approval for ticagrelor, including the drug in an official guideline still rankled some clinicians.&lt;/p&gt;
&lt;p&gt;A. John Camm, MD, of St. George&apos;s University in London, who served on a joint ACC/AHA/ESC guidelines committee, said the inclusion of an unapproved drug was &quot;inappropriate&quot;  --  adding that he would not recommend doing so.&lt;/p&gt;
&lt;p&gt;But Clyde Yancy, MD, of Baylor College of Medicine in Houston told &lt;em&gt;MedPage Today &lt;/em&gt;that it was &quot;neither inappropriate nor unprecedented for regulatory agencies and clinical guideline committees to have separate and distinct thresholds.&quot;&lt;/p&gt;
&lt;p&gt;He said that while the FDA &quot;uses reasonably safe and effective&quot; as its threshold for drug approval, guidelines committees focus on positive endpoints and &quot;clinically important outcomes&quot; when considering new treatments for inclusion in their guidelines.&lt;/p&gt;
&lt;p&gt;At the same time, Yancy added that including a drug not yet approved by any regulatory agency did push the envelope, and Smith, who has chaired a number of ACC/AHA and National Institutes of Health guidelines committees said he could not recall an incidence in which a drug unapproved worldwide was included in any guideline.&lt;/p&gt;
&lt;p&gt;Smith did, however, say that U.S. guideline groups have occasionally included recommendations about a drug that was already approved outside the U.S. but not approved by the FDA.&lt;/p&gt;
&lt;p&gt;Despite repeated requests for comment by the ESC on the new guidelines, &lt;em&gt;MedPage Today&lt;/em&gt; was unable to obtain a statement beyond these comments, issued in a press release:&lt;/p&gt;
&lt;p&gt;&quot;Our intention in writing these guidelines was to give patient-centered recommendations that lead to the most appropriate treatment regime for the different types of CAD. We also wanted to provide reference materials based on best practice but not conditioned by the skill and preferences of individual physicians. The major challenge faced by physicians is not how to treat the CAD patient, but which of the many treatment options to select.&quot; The comment was attributed to William Wijns, MD, PhD of the Cardiovascular Center in Moorselbaan, Belgium, who co-chaired the task force that wrote the new guidelines.&lt;/p&gt;
&lt;p&gt;Hours after the ESC newsroom closed, the staff sent this response by e-mail:&lt;/p&gt;
&lt;p&gt;&quot;We have asked for interviews with the Chairs of this Guideline Review and as yet we have not been able to confirm availability in the schedule for an appropriate person to provide comment.&quot;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;Smith said he had no disclosures.&lt;/p&gt;&lt;p&gt;Brindis is currently ACC president but has no additional disclosures.&lt;/p&gt;&lt;p&gt;Yancy said he had no disclosures.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_3204"
                     title="ESC: Long-Distance Running Appears Safe for the Heart (CME/CE)"
                     score="0.014"
                     href="http://www.medpagetoday.com/MeetingCoverage/ESCCongress/tb/21949?impressionId=1283457941608"
                     
      &lt;p&gt;STOCKHOLM  --  Men and women who participate in endurance competitive marathon events appear to develop some transient heart changes, but overall these activities do not seem to have long-term harm for the vast majority of individuals.&lt;/p&gt;
&lt;p&gt;In a series of reports presented at the European Society of Cardiology meeting, doctors found: &lt;ul&gt; &lt;li&gt;Older runners  --  those over age 50  --  developed some cardiac changes following running in Berlin marathons, but the changes in diastolic and right heart function did not exceed normal ranges.&lt;/li&gt; &lt;li&gt;There are ethnic and sexual differences in changes in heart muscle that should be recognized before athletes with enlarged hearts are disqualified from competition.&lt;/li&gt; &lt;li&gt;No significant cardiac changes occurred among participants who were engaged in a week-long overland and water endurance exercise program.&lt;/li&gt; &lt;li&gt;On the other hand, ultra-endurance running  --  races of 50 to 100 miles  --  resulted in elevation of troponin-1 which could be related to heart muscle damage; many of these runners also developed electrocardiographic changes.&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;On the whole, &quot;It is wonderful to see that older adults can participate in these endurance events without experiencing long-term heart damage,&quot; said Ileana L. Pina, MD, professor of medicine, epidemiology, and biostatistics at Case Western Reserve University, in Cleveland.&lt;/p&gt;
&lt;p&gt;&quot;Even if these individuals exhibit higher-than-normal biomarkers, these rapidly return to normal,&quot; Pina, a spokesperson for the American Heart Association, told &lt;em&gt;MedPage Today&lt;/em&gt; in Stockholm.&lt;/p&gt;
&lt;p&gt;In one study, researchers led by Fabian Knebel, MD, a cardiologist at the Medical Clinic for Cardiology, Angiology, Pneumology at the University Medicine Berlin, studied cardiac parameters for 167 runners --  all 50 years or older  --  who participated in the 2006 and 2007 Berlin Marathon races.&lt;/p&gt;
&lt;p&gt;They were examined 10 days before the race, immediately after running 26 miles, 385 yards in the marathon, and two weeks after the race.&lt;/p&gt;
&lt;p&gt;Knebel said that immediately after the race, the heart rate in these runner was elevated from baseline  --  88 beats per minute at the end of the marathon compared with 62 beats per minute before the race (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001), and 57.95 of the runners showed increases in troponin values.&lt;/p&gt;
&lt;p&gt;However, these changes proved transient, he said. &quot;Two weeks after a marathon, the key parameters were all back to normal levels,&quot; Knebel said. &quot;The concerns people have about marathon running causing sustained damage to the heart appear to be unfounded.&quot;&lt;/p&gt;
&lt;p&gt;In another study, researchers determined that Caucasian and black women athletes appear to have differences in anatomy which manifests as a larger heart among the black women.&lt;/p&gt;
&lt;p&gt;Sanjay Sharma, MD, professor of cardiology at Kings College, in London, established that about 3% of black women athletes have a left ventricular wall thickness greater than 11 mm  --  a level not exceeded by elite white women athletes. In black elite women athletes, the left ventricular wall thickness can reach 13 mm  --  a level that would be considered abnormal for white women athletes.&lt;/p&gt;
&lt;p&gt;He suggested that if sports policymakers used data derived solely from white athletes regarding what constitutes healthy heart function, &quot;it could unfairly discriminate against black athletes by leading to unnecessary investigation or even disqualification.&quot;&lt;/p&gt;
&lt;p&gt;In commenting on Sharma&apos;s study, Pina noted, &quot;We have known there are differences between the sexes in cardiology, but it also appears there are genetic differences that involve ethnicity as well.&quot;&lt;/p&gt;
&lt;p&gt;A third study that examined subjects who completed a five to seven day prolonged exercise event  --  an 800 kilometer cross-country running and boating test  --  found that the athletes who participated experienced no health-related abnormalities.&lt;/p&gt;
&lt;p&gt;Researcher C. Mikael Mattsson, PhD, at the Karolinska Institute, Stockholm, suggested that the lack of cardiac fatigue seen among the 15 athletes studied might have been due to the low intensity exercise of the cross-country trek. &quot;This might point towards exercise intensity, not duration, as the primary source for cardiac fatigue,&quot; he said.&lt;/p&gt;
&lt;p&gt;That might have been borne out among participants who completed either a 50-mile or a 100-mile road race, said John Somauroo, MD, professor of medicine at Countess of Chester Hospital, England.&lt;/p&gt;
&lt;p&gt;Of the 25 runners who completed the arduous race  --  beset by thunderstorms and driving rain  --  troponin levels were elevated in 21 of the men, and many developed bizarre electrocardiogram changes, Sumauroo and colleagues found.&lt;/p&gt;
&lt;p&gt;&quot;This study suggests that running continuously over 50 to 100 miles may not be good for the heart,&quot; Somauroo said.&lt;/p&gt;
&lt;p&gt;Aside from the long-distance studies, the lack of long-term damage to these athletes&apos; hearts may point to the human genetic makeup. &quot;In evolution we were selected out as hunter-gatherers where we would run and hunt miles from home to find enough food for the day,&quot; Stephen Gielen, MD, associate professor of medicine at the University of Leipzig, Germany, and a spokesman for the European Society of Cardiology, told &lt;em&gt;MedPage Today&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;&quot;It is astonishing the enormous exercise that the human heart can endure,&quot; he said. He noted that the long-distance running may be typical of the human condition that was developed before mankind became civilized.&lt;/p&gt;
&lt;p&gt;He did note that the long-distance running events that Somauroo reported may represent the &quot;edge of harmful&quot; events.&lt;/p&gt;
&lt;p&gt;Gielen said that individuals who decide to take up endurance running and are over age 40 should undergo cardiovascular screening before hitting the road.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;None of the investigators had any financial disclosures.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
</recommendedContent>