Rationale for Pre-Race Aspirin to Attenuate Risk for Marathon-Related Cardiac Arrest: Confounding the Legacy of Pheidippides

While increasing levels of recreational sports participation are incrementally cardioprotective, strenuous physical exertion transiently increases the risk for acute cardiac events including sudden death.  The frequency of marathon-related cardiac arrests has been increasing since the year 2000 mainly in middle-aged men due to atherosclerotic coronary artery disease.  Coronary artery calcium scores and post-race cardiac biomarkers are recommended to identify runners who might benefit the most from pre-race aspirin for enhanced primary prevention.