Rationale and design of the Measuring Athlete's Risk of Cardiovascular events (MARC) study

Background More than 90 % of exercise-related cardiac arrests occur in men, predominantly those aged 45 years and older with coronary artery disease (CAD) as the main cause. The current sports medical evaluation (SME) of middle-aged recreational athletes consists of a medical history, physical examination, and resting and exercise electrocardiography. Coronary CT (CCT) provides a minimally invasive low radiation dose opportunity to image the coronary arteries. We present the study protocol of the Measuring Athlete's Risk of Cardiovascular events (MARC) study. MARC aims to assess the additional value of CCT to a routine SME in asymptomatic sportsmen >= 45 years without known CAD.Design MARC is a prospective study of 300 asymptomatic sportsmen >= 45 years who will undergo CCT if the SME does not reveal any cardiac abnormalities. The prevalence and determinants of CAD (coronary artery calcium score >= 100 Agatston Units (AU) or >= 50 % luminal stenosis) will be reported. The number needed to screen to prevent the occurrence of one cardiovascular event in the next 5 years, conditional to adequate treatment, will be estimated.Discussion We aim to determine the prevalence and severity of CAD and the additional value of CCT in asymptomatic middle-aged (>= 45 years) sportsmen whose routine SME revealed no cardiac abnormalities.