Brief recommendations for participation in leisure time or competitive sports in athletes–patients with coronary artery disease: Summary of a Position Statement from the Sports Cardiology Section of the European Association of Preventive Cardiology (EAPC)
Restricted accessResearch articleFirst published online May, 2020
Brief recommendations for participation in leisure time or competitive sports in athletes–patients with coronary artery disease: Summary of a Position Statement from the Sports Cardiology Section of the European Association of Preventive Cardiology (EAPC)
This paper presents a brief summary of the recommendations from the Sports Cardiology section of the European Association of Preventive Cardiology (EAPC) on sports-participation in patients with coronary artery disease, coronary artery anomalies or spontaneous dissection of the coronary arteries, all entities being associated with myocardial ischaemia.1
Given the wealth of evidence supporting the benefits of exercise for primary and secondary prevention of coronary artery disease, individuals should be restricted from competitive sport only when a substantial risk of adverse event or disease progression is present. These recommendations aim to encourage regular physical activity including participation in sports and, with reasonable precaution, ensure a high level of safety for all individuals with coronary artery disease. The present document is based on available current evidence, but in most instances because of lack of evidence, also on clinical experience and expert opinion.
BorjessonMDellborgMNiebauerJ, et al.Recommendations for participation in leisure-time or competitive sports in athletes–patients with coronary artery disease – A position statement from the Sports Cardiology Section of the European Association of Preventive Cardiology (EAPC). Eur Heart J2019; 40: 13–18.
2.
AdabagAPetersonGAppleF, et al.Etiology of sudden death in the community: Results of anatomical, metabolic and genetic evaluation. Am Heart J2010; 159: 33–39.
3.
PiepoliMHoesAAgewallS, et al.2016 European guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice. Eur Heart J2016; 37: 2315–2381.
4.
MittlemanMAMaclureMToflerGH, et al.Triggering of acute myocardial infarction by heavy physical exertion. Protection against triggering by regular exercise. N Engl J Med1993; 329: 1677–1683.
5.
MonsUHahmannHBrennerH. A reverse J-shaped association of leisure-time physical activity prognosis in patients with stable coronary heart disease: Evidence from a large cohort with repeated measurements. Heart2014; 100: 1043–1049.
6.
ThompsonPDFranklinBABaladyGJ, et al.Exercise and acute cardiovascular events. Placing the risks into perspective. A scientific statement from the American Heart Association Council on nutrition, physical activity, and metabolism and the Council on Clinical Cardiology. Circulation2007; 115: 2358–2368.
7.
QuillardTFranckGMawsonT, et al.Mechanisms of erosion of atherosclerotic plaques. Curr Opin Lipidol2017; 28: 434–441.
8.
KimJHMalhotraRChiampasG, et al.Cardiac arrest during long-distance running races. Race Associated Cardiac Arrest Event Registry (RACER) Study Group. N Engl J Med2012; 366: 130–140.
9.
ShawLJWeintraubWSMaronDJ, et al.Baseline stress myocardial perfusion imaging results and outcomes in patients with stable ischemic heart disease randomized to optimal medical therapy with or without percutaneous coronary intervention. Am Heart J2012; 164: 243–250.
10.
ErbelRMöhlenkampSMoebusS, et al.Coronary risk stratification, discrimination, and reclassification improvement based on quantification of subclinical coronary atherosclerosis. The Heinz Nixdorf Recall Study. J Am Coll Cardiol2010; 56: 1397–1406.
11.
BörjessonMDellborgM. Exercise-testing post-MI: Still worthwhile in the interventional era?Eur Heart J2005; 26: 105–106.
12.
ShuvalKFinleyCEBarlowCE, et al.Sedentary behavior, cardiorespiratory fitness, physical activity, and cardiometabolic risk in men: The Cooper Center Longitudinal Study. Mayo Clin Proc2014; 89: 1052–1062.
13.
PellicciaAAdamiPQuattriniF, et al.Are Olympic athletes free from cardiovascular diseases? Systematic investigation in 2352 participants from Athens 2004 to Sochi 2014. Br J Sports Med2017; 51: 238–243.
14.
VanheesLRauchBPiepoliM, et al.Importance of characteristics and modalities of physical activity and exercise in the management of cardiovascular health in individuals with cardiovascular disease (Part III). Eur J Prev Cardiol2012; 19: 1333–1356.
15.
BörjessonMUrhausenAKouidiE, et al.Cardiovascular evaluation of middle-aged/senior individuals engaged in leisure-time sport activities: Position stand from the section of exercise physiology and sports cardiology of the European Association of Cardiovascular Prevention and Rehabilitation. Eur J Cardiovasc Prev Rehabil2011; 18: 446–458.
16.
VrintsCSeniorRCreaF, et al.Assessing suspected angina: Requiem for coronary computed tomography angiography or exercise electrocardiogram?Eur Heart J2017; 38: 1792–1800.
17.
PrioriSBlomstrom-LundqvistCMazzantiA, et al.2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J2015; 36: 2793–2867.
18.
FletcherGFBaladyGBlairSN, et al.Statement on exercise: Benefits and recommendations for physical activity programs for all Americans: A statement for health professionals by the Committee on Exercise and Cardiac Rehabilitation of the Council of Clinical Cardiology, American Heart Association. Circulation1996; 94: 857–862.
19.
NiebauerJHambrechtRVelichT, et al.Attenuated progression of coronary artery disease after 6 years of multifactorial risk intervention: Role of physical activity. Circulation1997; 96: 2534–2541.
20.
HarrisKCreswellLHaasT, et al.Death and cardiac arrest in U.S. triathlon participants, 1985 to 2016: A case series. Ann Intern Med2017; 167: 529–535.
21.
IqbalJZhangY-JHolmesD, et al.Optimal medical therapy improves clinical outcomes in patients undergoing revascularization with percutaneous coronary intervention or coronary artery bypass grafting: Insights from the Synergy Between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery (SYNTAX) trial at the 5-year follow-up. Circulation2015; 131: 1269–1277.
22.
ThompsonPDMyerburgRJLevineBD, et al.Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: Task Force 8: Coronary artery disease: A Scientific Statement from the American Heart Association and American College of Cardiology. J Am Coll Cardiol2015; 66: 2406–2411.
23.
HillSFSheppardMN. A silent cause of sudden cardiac death especially in sport: Congenital coronary artery anomalies. Br J Sports Med2014; 48: 1151–1156.
BassoCMaronBJCorradoD, et al.Clinical profile of congenital coronary artery anomalies with origin from the wrong sinus leading to sudden death in young competitive athletes. J Am Coll Cardiol2000; 35: 1493–1501.
26.
NishiguchiTTanakaAOzakiY, et al.Prevalence of spontaneous coronary artery dissection in patients with acute coronary syndrome. Eur Heart J Acute Cardiovasc Care2016; 5: 263–270.
27.
RashidHWongDWijesekeraH, et al.Incidence and characterisation of spontaneous coronary artery dissection as a cause of acute coronary syndrome – a single-centre Australian experience. Int J Cardiol2016; 202: 336–338.
28.
TweetMHayesSPittaS, et al.Clinical features, management, and prognosis of spontaneous coronary artery dissection. Circulation2012; 126: 579–588.
29.
CerratoEBarberoUD’AscenzoF, et al.What is the optimal treatment for symptomatic patients with isolated coronary myocardial bridge? A systematic review and pooled analysis. J Cardiovasc Med2017; 18: 758–770.
30.
TarantiniGMiglioreFCademartiniF, et al.Left anterior descending artery myocardial bridging: A clinical approach. J Am Coll Cardiol2016; 68: 2887–2899.
