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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.
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