Monday, April 23, 2018

Guest Post: Stewart Dutfield's Q1 Somewhat Running-related Diary

I'm happy to welcome back the musings of Stewart Dutfield to the blog.  Stewart was kind enough to share his diary of 2017 at the end of last year.  I really enjoy his deep thoughts, both running- and non-running-related.  This year hopefully he'll continue to update us on a seasonal basis with his distinctively British observations of the world around him.


1 January. The rituals of this time of year reassure us that life continues in a familiar pattern, but perhaps they also show us what has changed. A longtime Christmastime staple for its scene of Kolkata's Howra Station set to "Silent Night" is 36 Chowringhee Lane, produced by the late Shashi Kapoor: a melancholy Indian movie about people out of place & time. Its earlier cousin, Shakespeare Wallah, also evokes the sadness of holdovers from the Raj and the dubious attractions of modernity. Watching it now, I feel out of step with a contemporary world that every day echoes Rimbaud's Démocratie: "ours will be a ferocious philosophy, ignorant as to science, rabid for comfort, and let the rest of the world croak."

SUNY Plaza Tower
4 January. East of the Greyhound terminal in downtown Albany, a tall Gothic structure glowers over a row of businesses that look like Ireland 50 years ago. What is now SUNY Plaza was newly-built just when its model, the Cloth Hall at Ypres, was destroyed in 1914. With snow falling hard, this was a good day to walk a few times up and down the 12-story tower. One climb more than I had done previously amounted to the height of the Empire State Building observation deck. Having over a few years gradually increased the number of repetitions, perhaps I am fit at last for this to be a weekly training workout.

9 January. The tunnels at UAlbany form a kilometer-long rectangle of concrete and ductwork. During winter break, largely empty of students moving between academic buildings, they see an occasional subterranean interval session. Some runners—me for one—turned up as much from curiosity as to be out of the winter weather. I discovered that it's easy to lose count of right-angle corners in a tunnel, unless running hard and gasping for a brief rest.

11 February. The Pine Hollow Arboretum was farmland returned to pine forest in the 1960s, when its pediatrician founder started to build ponds and plant trees. It grew from backyard landscaping to a lifelong calling, with several thousand specimens—some rare, and many beyond their native range—and a tangled couple of miles of trails. So far I have visited this local treasure mostly in winter, and am yet to see the magnolias and azaleas in bloom. On this day, running in wet snow, I visited my favourites so far: the Japanese specimens, the knees surrounding a bald cypress, and the "Glacier Ridge" trail along what to this untutored eye appears to be a short esker (Eiscir in Robert MacFarlane's word-hoard).

Cypress Knees
18 February. Since 1973, the low-key and by now old-style Winter Marathon has started at UAlbany and followed a succession of inner and outer loops round the New York State office campus. More than once, I have called it a training run and quit several miles short of finishing. Today it was breezy, and too warm for ice to form on cups of water at the rudimentary aid stations. Qualifying for Boston was never a concern 30 years ago, but I haven't been close now for a long while. On a pace at half way within that limbo between a qualifier and a time fast enough to actually enter, I didn't fade much and ran faster than in several years: so no Boston qualifier, but the task of recovering and continuing to train.

4 March. Two months after its appearance in the London Review of Books, I read Alan Bennett's diary for 2017. Humbled by the pale imitation that this journal is of the great man's work, I also feel gratified to learn that he and I were reading the same Borges story at around the same time last November.  

8 March. A snowmobile passed by on the rail trail this morning while I was walking the dog. I took the opportunity to trace its tracks—similar to those I saw a year ago when snowshoeing home from work—over local  streets and neighbors' yards to their source. A while later, our town's competent police department called to inform me that Plod and the enthusiast in question had had a quiet chat.

10 March. Scotland has its Munros and Corbetts, summits above 3,000 and 2,500 feet respectively, and the Catskills have the 3500s. Joe had set out to climb all 35 in the winter months, and West Kill Mountain would be the last. His retinue—a few more and we'd have needed a permit—strapped on snowshoes for the 1,800-foot ascent by way of Diamond Notch Falls and an excellent ridgetop viewpoint. We celebrated at the top, more demurely than Scott Jurek's notorious debauch after narrowly breaking the Appalachian Trail record, and Mike recalled that he is now exactly half way through a second Catskill Grid: each 3500 foot summit climbed in each month of the year. It takes focus to bag 420 summits, and yet more to keep an exact tally in mind at all times. The vicar who genially characterized me as obsessive at my father's funeral had no idea what people are capable of.

The view south from West Kill
11 March. I have been watching the BBC documentary on Eddie Izzard's run around Britain of a few years ago: extraordinary because shortly before those weeks of back-to-back marathon distances he claimed no history of running. There's something very un-Church of England about such audacity.

24 March. Where the Susquehanna River flows into Chesapeake Bay, Steppingstone Farm Museum preserves a glimpse of rural life in its stone house, carriage barn, and old cannery. The 50K HAT Run starts and finishes here, also passing through after four and 17 miles. The course through "The Land of Promise" and Susquehanna State Park was partly covered with snow. I splashed through the knee-deep Rock Run creek and passed the late 18th century grist mill for the second time, still feeling strong with four miles left to run; as the day warmed and several hundred pairs of feet passed by, the trail had by now turned to a treacherous mud. For some reason I love these conditions, and in a dozen races here have finished faster only once.

Friday, April 20, 2018

Spring Update: Searching for Consistency

My ambivalence toward writing this post--or really toward blogging in general recently--is clearly a reflection or manifestation of my recent ambivalence towards basically everything.  As with many of us who are all too consumed with our running, whose general outlook fluctuates in rhythm with our training cycles, when my running isn't going well, I generally don't have much of an interest in anything else.  It must be nice to be someone who derives pleasure or satisfaction from their job.  What's that like?

I took three weeks off after Bandera.  I tried to pretend that I wanted an offseason and felt great about my plan going forward, but to be honest I was floundering.  I had no real desire to run and nothing really to train for, unsure if I'd be able to run Leadville and undecided as to whether I really wanted to.  I gained enough weight that when I started running slowly again I felt bloated and awkward.  I had nagging aches and pains in various areas and couldn't find any sort of consistent rhythm.  Hearing about some of the great performances people were posting around the country and the world didn't help, either.  I've been struggling with the usual crisis of confidence that follows any bad performance, and superimposing others' successes on that sense of failure was having less than positive effects.

Oh, and I didn't win Blogger of the Year.  (Though I was a finalist for the second year in a row).   Thanks to those who voted.

It took until March before some semblance of motivation returned.  I decided to commit to Leadville and started to get at least a little excited about it.  I had some very sub-par "quality" workouts, but at least I was getting out there again, and it was only a matter of time before things started clicking again.

And then I blew out my calf.

Well, that's a bit dramatic.  I strained something that niggled on and off for a couple of weeks, causing me to cut short a couple of runs and gimp my way through a few others, until it finally seized up midway through a pretty decent tempo workout with Brian and I had to hobble a few miles back to the car.  That laid me up for almost a week, but with some help from the brilliant Dave Ness and Scott Field at Performance Sports and Wellness, I've been back on my feet for almost two weeks, and I'm finally--finally--starting to find a little bit of fitness.  Fortunately my ennui seems to have cleared a bit, and I'm actually starting to look forward to a spring and summer of training and racing.

I've had two other projects occupying the time that I'd usually devote towards the blog in recent months.  One is the launch of a silly little podcast called The Pain Cave, which I conceived as a show that examines some of the scientific issues and bases behind endurance sports in general and ultrarunning in particular.  It's been a challenge, and I've been having fun figuring it out and talking with some cool people--many of the characters you'll recognize from this blog, but also some other pretty interesting folks.  I'd like to continue to keep talking about and de-mystifying the scientific stuff, but I'm also going to expand to just ultrarunning in general, especially in the next couple of weeks, so check that out.  The other time suck I can't talk too much about right now; as you may know I've been doing some exercise physiology stuff recently and I'm working on a proposal to expand that into a much larger, more comprehensive running/sports medicine facility, which has been an exciting though uncertain prospect.  Hopefully I'll have more to say about that in upcoming posts.

I do have some low-key races and other running-related fun coming up, so I anticipate some more regular posting soon.  Plus next week Stuart Dutfield returns with a guest post on his 2018 to date.  His diary from 2017 was one of the more bizarrely entertaining things I've read in awhile, so you've got that to look forward to at least.

Thursday, January 11, 2018

Bandera Post-Mortem: Finish at All Costs?

So, Bandera went very, very badly.

Usually I like to do a pretty detailed race report, but I don't have a lot of details to report from this one other than that it was bad.  I felt bad at the start, I felt bad on the first climb, I pretty much felt bad throughout.  I was hoping to run the first half of the race at about 8:30 pace--similar to what I had run two years ago through the first lap--but struggled to run 9:00/mile pace over the first 16 miles through AS3.  Rather than slow down, I tried speeding up to see if I could run my way out of feeling badly, and hammered the next six miles at just under 8:00 pace, coming through 22 miles at 3:12, within striking distance of the sub-4:30 I wanted to run through the first 50K, but it wasn't working; I started to feel worse and worse.  I finished the first lap in 4:46, about twenty minutes slower than two years go, and spent a few minutes convincing myself to head back out for lap two.  I'd like to report that I found my legs in the second half and had a strong finish, but I didn't.  I ran-walked for the first two hours of the loop before getting a sort-of second wind and running consistent 10-11 minute miles for the next couple of hours, ultimately finishing up in 11:19, nearly two hours slower than my breakthrough run in 2016.

The spoils of mediocrity.
This was my sixth national championship race since turning 40, and despite five top-3 age group finishes (Bandera, Caumsett, and North Coast in 2016, Rocky Raccoon and Cayuga in 2017), I was still searching for my first age group title.  Somehow, in what was easily my worst performance as a masters runner, I was able to secure my first age group national championship. All it took was running a terrible race, having Paul Terranova not show up, and having Chad Lasater age up to the 45-49 group.  What a silver lining.

One sentiment I hear all the time is that you learn more from races that go poorly than races that go well.  This sounds like a very wise thing to say, but I don't think it's true.  I take many lessons out of strong performances: I know what workouts were beneficial in my training, what worked in terms of race strategy and nutrition, and where I can expect to race relative to my competition.  I suppose there are lessons to be learned from failure, if you can attribute a poor race to a mistake you made in strategy, preparation, or fueling.  In this case, though, it's hard to feel like I learned anything that will help me the next time out.  My training for the race had been nearly ideal, and I certainly didn't feel as if there were any aspects of my preparation that were missing; my times in the short prep races were comparable to those I'd run in the previous two years.  I wasn't out too fast, either, actually running a slower pace than planned for the first 16 miles (which was hard to do with a huge field of fast guys hammering at the front).  Maybe I was overtrained; maybe I had pushed some workouts too hard; maybe I was too focused on hitting splits over the first 50K that I got out of my comfort zone too early.  Maybe, maybe, maybe.

Sometimes when people invoke that maxim--that we learn more from defeat than from victory--they are speaking less of concrete lessons that can help us apply changes to future performances, and more about the nebulous idea that we learn about ourselves and our limits when "the going gets tough."  That we have more strength than we think, that we didn't give up, that we can push through the next time we hit a bad patch.  In a way I suppose this is true--you do need to suffer at some point in a race to learn how to deal with that suffering.  Without learning that suffering can be endured, that it passes and gets better, we'd never make it through the rough stretches that define ultra running, and we'd never finish a race when we hit a bad patch.  I'm not someone, though, who believes this is a lesson we need to learn over and over.  I've been running races since I was twelve years old; I don't need to be reminded how to deal with suffering.  I've never subscribed to the finish-at-all-costs mentality.  I know I can finish; I'm not entering races to prove it to myself over and over again.  I run races to challenge myself to perform and to compete against other runners at a high level.  Everyone enters a race with a baseline goal of "just finish," but should we?  What did I get out of walk-running through a 6:30 50K over the second half of that race?  I accomplished none of my goals (other than the aforementioned age group win, which had nothing to do with me).  I didn't learn anything new about myself or my "limits".  I finished a race that I had no doubt I could finish very slowly if I needed to.  I got the same belt buckle I got two years ago.  (It's a very cool buckle, but still.)  Am I any more satisfied with this experience than I would've been if I'd stopped after a single very disappointing lap?  And if I am, should I be?  By any objective measure--my time, my place, my position in the field relative to other runners I know--this was a terrible performance.  Why should the fact that I was able to walk for several hours to avoid a DNF mitigate that in any way?

If you've got a brilliant answer, I'm all for it.  All I can come up with is that I now have four tickets in the lottery for Western States in 2019.  Here's to another opportunity to humiliate myself.

Thursday, January 4, 2018

Ultrarunner of the Year: My Ballot

I was honored to be included once again on the voting panel for Ultrarunning magazine's prestigious Ultrarunner of the Year award.  This was my third time voting, and it isn't getting any easier.  I know I complained last year, but at least in 2016 the top spots for both the men and women were pretty obvious.  This year we had no such luck.  I think pretty much everyone will agree on the top two women, although in which order they ultimately wind up is anyone's guess; I spent nearly as much time deciding between the two of them as I did on the rest of the entire ballot.  The remainder of the ballot was pure torture as usual.  I'm thrilled that I get to keep voting, but it really is an excruciating process and by the time I'm done my stomach usually hurts pretty badly.

Posting my ballot has inspired a lot of good-natured (and not-so-good-natured) criticism in the past, and this year with the launch of my new podcast, The Pain Cave, I decided to be a bit proactive in addressing this.  I invited New York ultra stud Jason Mintz, one of my staunchest (if friendliest) critics, on the pod to debate our picks.  Unfortunately Mintz had to cancel at the last minute, but our mutual friend Laura Kline was kind enough to step in and provide the counterpoint to my ballot.  Listen to the episode here; I'll list my ballot below, but Laura and I get into the nitty-gritty a little bit more and really go through our reasoning and justification for some of the decisions we had to make.

I don't yet have the final results tabulated for the Gunksrunner Ultra Rankings for this year, which is unfortunate since I like comparing them to my ballot.  I hope to have the results finished by the time Ultrarunning publishes the UROY results, and we can do a little comparison then.

Just a reminder: FKTs are not to be considered in this voting, not for UROY or Performance of the Year.  A separate committee votes on the top FKTs of the year.  So, feel free to tear apart my ballot, but dear god, don't criticize me for not including FKTs.

Women's UROY
1. Camille Herron
2. Courtney Dauwalter
3. Clare Gallagher
4. Katylyn Gerbin
5. Magdalena Boulet
6. Jacqueline Merritt
7. Kelly Wolf
8. Katalin Nagy
9. Cat Bradley
10. Devon Yanko

I'm not going to delve deep my reasoning for any of these categories; listen to the podcast as we spent nearly an hour doing that and I don't feel like rehashing that here.  The Camille vs. Courtney debate for the top spot was incredibly difficult, but Clare Gallagher was a pretty easy choice, for me at least, at #3.  Spots 4-6 were basically identical and I would've been happy with any order.  Toughest omissions: Keely Henninger, Anna Mae Flynn, Kathleen Cusick, Hillary Allen, Megan Kimmel, Sarah Bard, and Sabrina Little.

Women's Performance of the Year
1. Camille Herron's 100 mile WR at Tunnel Hill
2. Camille's win at Comrades
3. Courtney Dauwalter's 24-hour AR at Soochow
4. Camille (again!) 12-hour WR at Desert Solstice
5. Rory Bosio's overall win and women's CR at Tahoe Rim Trail 50-mile

Tough omissions were Cat Bradley's unexpected come-from-behind win at Western States, Clare Gallagher's win at CCC, Courtney's dominating win at Run Rabbit Run (despite temporary blindness), Katalin Nagy's (transient) 24-hour AR, and Michelle Leduc's Canadian Record at 100 miles (made easier to leave off the list by the fact that Camille ran over two hours faster this year).

Women's Age Group Performance of the Year
1. Liz Bauer (58 years old), first at Across the Years 6-day (418 miles)
2. Meghan (Arbogast) Laws (56), 9th at Western States
3. Sally Brooking (61), 4th at Mountain Mist 50K (5:46--and that's not an easy course)
4. Roxanne Woodhouse (54), first at Tahoe Rim Trail 100-mile
5. Jean Herbert (61), 9:21 at JFK 50

Men's UROY
1. Tim Tollefson
2. Jim Walmsley
3. Alex Nichols
4. Tim Freriks
5. Avery Collins
6. Sage Canaday
7. Mark Hammond
8. Hayden Hawks
9. Max King
10. Patrick Reagan

God, was this an unpleasant task.  Again, listen to the podcast for most of my reasoning; Laura and I discussed if it's fair to grade Jim on a curve, how much a DNF should count against you, why I'm such a Cornell XC homer, and the importance of big international races like CCC, Comrades, and UTMB.  My toughest cuts in this category: Dylan Bowman, Bob Shebest, Olivier Leblond, Jeff Browning, Jason Schlarb, Cody Reed, Brian Rusiecki, Kris Brown, Anthony Kunkel, and Eric Senseman.

Men's Performance of the Year
1. Olivier Leblond's 48-hour AR (262 miles)
2. Geoff Burns' 5:14 at Chicago Lakefront 50-mile
3. Tyler Jermann's 2:48 50K at Caumsett
4. Hayden Hawks' win at CCC
5. Guillame Calmettes' win at Big's Backyard Ultra

I found this category much easier this year than last, for some reason.  Jim had some amazing performances again this year, but nothing that captured the imagination of the ultra world like many of his 2016 exploits.  For some reason Tim Tollefson's third place finish at UTMB was fifth on my ballot last year but not this year.  So much for internal logic.  But I was much happier with this list than with my UROY top 10.  Toughest snubs: Jim's CR runs at Tarawera and Gorge Waterfalls, Tim's aforementioned UTMB race (and Jim, DBo, and Zach at UTMB, for that matter), and Tim Freriks' two huge wins at Transvulcania and North Face.

Men's Age Group Performance of the Year
1. Thomas Devers (60 years old), 3:38 50K (and first place) at the Tallahassee Distance Classic
2. Bob Hearn (51), 151 miles in 24 hours at Run4water
3. Rich Hanna (52), 6:18 at American River 50-mile
4. Jean Pommier (52), 3:19 at Jed Smith 50K
5. Gene Dykes (69), finishing the Triple Crown of 200s

So there you go.  Same rules from last year apply: feel free to rip me apart in the comments, but you have to vote for me for Run Ultra's Blogger of the Year first.  Cast your vote and flame away!

Monday, December 25, 2017

Guest Post: Stewart Dutfield's 2017 Journal

And now for something a bit different...

Local ultrarunner Stewart Dutfield was kind enough to share the diary he's been keeping for 2017 and I thought it would be fun to include it here. His journal is based on the diary of fellow Brit Alan Bennett and is a cool glimpse into the thoughts of a dedicated runner who enjoys experiencing the world around him. Hopefully Stewart will keep us updated with some semi-regular posts in 2018.


Trail markers at the terminus of the Long Path imply that it continues northward...
13 January. Old Stage Road, above Altamont in Albany County, is currently the northern terminus of New York's Long Path; Ken Posner's recent book describes his 350-mile journey that ended here with a wry twist. On a clear, cold Friday evening 18 of us arrived at the trailhead for a the first full moon adventure of the year. People had traveled for hours, from Connecticut and Westchester, to walk five miles in the dark and watch moonrise over the Hudson Valley. After Dick had fallen hard on ice fifty yards in, we encountered good footing except on the dirt roads (back country ice skating, anyone?). The trail climbed hardly at all, but the view from High Point took in all of Albany and beyond. The informal trail along the cliff edge led, at one point with the rising moon directly ahead, to another high overlook at Hang Glider Point. As we took snapshots of people doing headstands, a bright light emerged from the woods: a fat-tire cyclist, no doubt as surprised to see us as we were to see her. 

Wednesday, December 6, 2017

Blogger of the Year, Take Two!

I'm very happy to announce that for the second straight year I've been shortlisted by the fine folks at RunUltra for the Ultra Blogger of the Year award.  RunUltra is a UK-based website that is an amazing repository of all things ultrarunning.  Their content runs the gamut: training advice, gear reviews, reporting on elite results from all over the globe, articles on physiology, motivation, race preparation, and basically anything else you might want to know in the ultra world.  Those guys (and gals!) know their to be named once again to their shortlist of candidates is truly an honor.
Last year's vote came down to the wire, though a closer examination of the balloting apparently revealed some...irregularities.  I can neither confirm nor deny reports of Russian hacking.  Anyway, the great Sarah Lavendar Smith, author of the superb blog "The Runner's Trip" (as well as The Trail Runner's Companion, an excellent book) was ultimately named a most deserving winner.  Sarah's up for the award again this year, so let's see if we can give her a (legitimate) run for her money.

This was kind of a big year for us here at "A Muddy Par of Heels."  I tried to branch out a little with the Running and Your Heart series of posts, adding a bit of an informative/academic bent that I hope people found useful, in addition to the usual race reports and other nonsense you've come to know and love.  Also this year I launched my podcast, "The Pain Cave," a series of conversations about running in general and ultrarunning in particular that takes a closer look at some of the science behind the sport, and other relevant issues of the day.  I view the blog and the podcast as kind of a companion set; hopefully each has helped enhance your enjoyment of the other.  (You can find The Pain Cave on my new website,, which is still a work in progress but ultimately should bring all my various running-related interests under the same tent.)  Unfortunately Lexi didn't quite hold up her end of the bargain this year--she's busy co-writing a novel about dragons with a friend of hers--so if I don't win I suppose I can blame it on her.

If you enjoy the blog, please take a moment to vote for me on the RunUltra website.  (You can use that link there, but I also figured out how to link the voting page with the image at the top of this post--if you just click on the badge at the top of the page, it takes you right to the voting!  If that's not enough of a reason to vote for me, I don't know what is.)  Scroll down to my name--I'm the eighth name on the left side, just above some punter named Jeff Browning--and click "Vote" under my name.  Wait, you're not done!  Now scroll all the way down to the bottom of the page, fill in your name and email address, and press "Enter."  You should get a new screen that confirms you've voted.  Thanks!  One vote per email address please; we don't want any monkey business this year.  Voting runs until January 14.  Just do it now before you forget.  As a cool bonus, everyone who votes is automatically entered in a drawing for a super cool Suunto Trainer watch.

In all seriousness, thank you for all your support of this blog.  It's a silly pursuit, I know, but it really means a lot when I get positive feedback from people who read the posts and let me know they've gotten something positive out of it.  I'll keep bugging y'all to vote, and I hope I win, but just having that kind of support is what keeps me plugging away at this thing.  But, seriously, go vote now.

Sunday, December 3, 2017

Running and Your Heart, Part V: Coronary Calcifications

So I thought I was done with the Running and Your Heart series, but some questions came up that made me realize I needed to clarify a couple of points.  And I don't know, maybe we're not done with the series; I could see doing some more in-depth posts in the future about some specific issues.  A detailed post on atrial fibrillation might be in order.  For now, though, we're going to delve a bit deeper into coronary calcifications, their significance, and what the research means for us as distance runners.
image: the Heart Research Institute

As such, think of this post less as the fifth installment in the series and more as part IIIb, as we'll be addressing basically what we talked about in part III (and touched on briefly in part IV).  Let's recap some of the main points from that post.  The coronary arteries are blood vessels that carry blood to the heart muscle, supplying that muscle with the oxygen needed to carry out its function--namely, pumping blood throughout the body.  Blood flow through these blood vessels can be compromised by a disease process called arteriosclerosis--literally, a hardening of the arteries.  Generally, arteriosclerosis is caused by the accumulation of plaques within the walls of the arteries, resulting in a narrowing/hardening of the arteries (stenosis) that can impede the flow of blood to the heart muscle.  In times of increased stress on the heart (i.e., exercise), the demands of the heart muscle for oxygen are increased; if not enough blood is able to flow through these narrow, stenotic arteries to meet this demand, the heart muscle suffers from ischemia (lack of oxygen).  Prolonged ischemia, or complete occlusion of the artery, can lead to infarction, or death of a part of the heart muscle--which, if significant enough, can be debilitating or fatal.

Remember that in part III, we discussed the use of CT scans in detecting underlying coronary artery disease--namely, looking for calcium deposition in the coronary arteries.  Calcium is a component of many arterial plaques and is easily visible on high-resolution CT scans.  This test is especially useful in folks who don't have any symptoms of coronary disease but may have risk factors.  A growing body of research indicates that long-term endurance athletes--those who have been training at high levels or volumes for a decade or more--paradoxically have higher rates of coronary calcification than those of their age-matched peers in the general population, despite having much lower rates of many risk factors, like diabetes, hypertension, or obesity.  Remember that these studies have demonstrated correlation, not causation--we can't say that sustained exercise is the cause of this finding, only note that the relationship exists.  And recall also that we've yet to demonstrate what the real-world implications of these findings are--which is the point of this more involved discussion. To wit, the question: does having more coronary calcification lead to a higher risk of having a cardiac event?  The short answer is, yes--but for marathon runners, maybe not.

Numerous studies of the general population (that is to say, not specifically among marathon/ultramarathon runners) have correlated coronary artery calcification (CAC) scores to a higher risk of suffering a cardiac event, such as heart attack, death, or the need for revascularization (a re-opening of a blocked artery).  The exact degree of risk varies by study, but ranges from a four-fold risk increase to a twenty-fold increase have been reported in studies of varying size and quality.  Higher CAC scores are associated with a higher degree of risk, with significant risk increases generally seen with scores above 100 or 300 (zero is "normal").

OK, so that's bad.  Higher scores are associated with higher risk, and we've demonstrated that "obsessive" runners have higher scores, on average, than the general population.  That means our risk of suffering a significant cardiac event must be much higher, right?  Well, not necessarily.  First off, as I mentioned in the earlier post, there is research suggesting that long-term aerobic exercise leads to coronary arteries that have larger diameter, and have a greater ability to dilate.  (The autopsy of seven-time Boston Marathon champion Clarence DeMar famously revealed that his coronary arteries were two to three times wider than average.)  Secondly, to better understand our level of risk, we need to understand the nature of arterial plaque and the reasons one might suffer from a cardiac event.

Generally, narrowing of the coronary arteries, in and of itself, is unlikely to cause a cardiac event.  The precipitating factor in a cardiac event is often the rupture of an arterial plaque.  A piece of the plaque can break off and get carried "downstream" to a narrower part of the artery.  If it gets lodged there, it can cause a complete occlusion of blood flow to an area of the heart muscle, resulting in a heart attack.  So if we can identify which plaques are more susceptible to rupture, this will allow for a better stratification of risk.

Simply put, not all plaque is created equal.  Arterial plaque is generally composed of various substances: fat, cholesterol, calcium, and fibrin, to name a few.  One way of thinking of plaques is to classify them as either "hard" or "soft".  Hard plaque, made up of predominantly calcium, is generally considered more stable and less prone to rupture than softer (mostly cholesterol) or "mixed" plaque.  The good news is that while high-volume exercisers have higher CAC scores, they are much more likely to have hard, calcific plaques (read: stable) and much less likely to have mixed plaques than subjects who exercised the least.

So while we know that elevated CAC scores in the general population put people at risk for cardiac events, the risk for runners who have elevated CAC scores may not be the same, because of the composition of their plaques, and possibly the dilation of their coronary arteries.  Perhaps this is why, despite the fact that runners appear to have paradoxically higher-than-expected rates of calcification, cardiac events among habitual marathoners seem to remain relatively infrequent occurrences.