While proficient cardiac resuscitation has improved survival following cardiac arrest during road races in Japan, this accomplishment does not address coronary artery disease as the underlying cause of an increasing frequency of cardiac arrest in middle-aged men during marathons and ironman triathlons in the United States since the year 2000. Based on the high prevalence of subclinical coronary artery disease by cardiac computed tomography in endurance athletes with low conventional cardiac risk-factor profiles, we recommend coronary artery calcium scores as a more reliable and independent predictor of incident cardiac events, including death, as validated among adults aged 30-46 years. Scores of over 100 Agatston units indicate a 10-year cardiac risk of 7.5%, at which additional measures for primary prevention are recommended, including aspirin, as shown conclusively to reduce first myocardial infarctions in same-aged men in a prospective double-blind controlled trial. Targeted screening for subclinical coronary atherosclerosis with coronary artery calcium scores is prudent to guide appropriately dosed aspirin use to mitigate the increasing frequency of sports-related sudden cardiac death due to plaque rupture.


Dr Siegel’s research on Boston Marathon runners has advanced the prevention and treatment of rare but life-threatening conditions such as acute water intoxication and cardiac arrest in young female and middle-aged male participants, respectively. Novel emergent treatments for the former have been incorporated into consensus statements accepted worldwide and also into the evaluation of hyponatremia in psychiatric practice. Pre-race aspirin use to mitigate the increasing frequency of marathon-related cardiac arrest in middle-aged male runners has been most recently advanced in the Annals of Internal Medicine, July, 2019. His interest in strategies to promote workplace resilience will be presented at the Creativity and Madness Conference in Charleston, South Carolina, in 2020, after attending this meeting as a recipient of a Joy in Learning Mini-Sabbatical from the MGH Center for Physician Well-Being,