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This review examines the evidence that extremes of endurance exercise may increase cardiovascular disease risk by reviewing the causes and incidence of exercise-related cardiac events, and the acute effects of exercise on cardiovascular function, the effect of exercise on cardiac biomarkers, including \u201cmyocardial\u201d creatine kinase, cardiac troponins, and cardiac natriuretic peptides. This review also examines the effect of exercise on coronary atherosclerosis and calcification, the frequency of atrial fibrillation in aging athletes, and the possibility that exercise may be deleterious in individuals genetically predisposed to such cardiac abnormalities as long QT syndrome, right ventricular cardiomyopathy, and hypertrophic cardiomyopathy. This review is to our knowledge unique because it addresses all known potentially adverse cardiovascular effects of endurance exercise. The best evidence remains that physical activity and exercise training benefit the population, but it is possible that prolonged exercise and exercise training can adversely affect cardiac function in some individuals. This hypothesis warrants further examination.<\/jats:p>","DOI":"10.1152\/physrev.00029.2014","type":"journal-article","created":{"date-parts":[[2015,11,25]],"date-time":"2015-11-25T21:54:26Z","timestamp":1448488466000},"page":"99-125","source":"Crossref","is-referenced-by-count":197,"title":["Are There Deleterious Cardiac Effects of Acute and Chronic Endurance Exercise?"],"prefix":"10.1152","volume":"96","author":[{"given":"Thijs M. 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