Clinical and necrops observations are described in five white male runners aged 40 to 53 years (average 46 years) who ran 22 to 176 km/week (mean 53 km) for 1 to 10 years (mean 5). None had clinical evidence of cardiac disease before they became habitual runners, and all died while running. At necropsy all had severe atherosclerotic luminal narrowing of their major epicardial coronary arteries. Of the five runners, at least four had hypercholesterolemia, two had systemic hypertension, one had angina pectoris and none had clinical evidence of an acute myocardial infarct. The single symptomatic runner also had an abnormal resting electrocardiogram and a positive exercise stress test. The electrocardiogram (four patients) and exercise stress tests (three patients) in the other four runners were normal. At autopsy, all five men had greater than 75 percent narrowing of cross-sectional area by atherosclerotic plaques of the right, left anterior descending and left circumflex coronary arteries. In three men the entire lengths of these three coronary arteries and also the left main coronary artery were examined histologically (total 5 mm segments = 153); 73 (48 percent) of the segments were narrowed greater than 75 percent in cross-sectional area by atherosclerotic plaques and 32 (21 percent) were narrowed by 51 to 75 percent. Four of the five runners had healed (clinically silent) myocardial infarcts. Thus, coronary heart disease appears to be the major killer of conditioned runners aged 40 years and over who die while running.
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