What do Olympic hopeful Ryan Shay, who died in the opening miles of the 2007 Olympic Trials Marathon in New York City, and two runners who died at this year's New York City Marathon have in common?

And what lessons can we learn from them to run next spring's marathon safely?

Shay, a young, highly fit and trained athlete, died at Mile 5 of the marathon from a rare inherited heart condition called cardiomyopathy. Even though the condition is rare, it is the most common cause of heart-related death in people under 40.

Cardiomyopathy is marked by a heart murmur that decreases when lying down and symptoms, such as shortness of breath or chest pain or tightness, in about one-third of individuals with this condition. Their hearts are unusually large with a disproportionately large left ventricle.

Even though this condition is rare and life-threatening, it is easily diagnosed by an EKG. In Italy, this test is a routine part of scholastic athletic screening. It is not customarily administered in this country because it is not considered cost effective and can produce false positives in results, leading healthy individuals to limit their activity needlessly.

In runners over 40, coronary artery disease is the major cause of sudden heart death. Like their younger counterparts, older runners who die during or following marathons appear healthy. It's their healthy habits that often mask the seriousness of their disease.

Runners don't normally exhibit the same disease indicators as nonrunners. Marathon runners fall within normal body weights and BMI, don't smoke and have good cholesterol numbers.

But a 2008 study in the European Heart Journal reports that 36 percent of experienced marathon runners over the age of 50 exhibited significant coronary artery calcification, with 9 percent requiring medical intervention in the two years following their marathon. It appears that runners can have normal blood flow despite serious atherosclerosis because their training builds smaller vessels that handle the load for the clogged larger ones.

Strenuous exercise, including marathon running, increases the risk of heart attack. From 6 to 17 percent of all sudden heart deaths are associated with exertion, whether running, jogging up a flight of stairs or shoveling snow.

In exertion, blood rushes through arteries at a faster rate. This increased flow causes plaque on the artery walls to tear or break off. Clots formed at these fissures or plaque sites then clog vessels and reduce blood flow to the heart.

Marathon runners may be at additional risk of clot formation for two reasons. First, the strenuous exercise of the marathon causes an inflammatory response within the body. Proteins in the blood released as a result of this inflammation are associated with cardiac events. Second, blood in many marathon finishers is thickened by dehydration and contains an above-normal number of damaged red blood cells, putting additional strain on the heart.

While marathon running can seem like a dangerous activity, runners are still healthier than those who don't exercise. And, as with most running injuries, heart injuries are more easily prevented than repaired.

Pay attention to heart-healthy eating. Have cholesterol and HSCRP, an indicator of inflammation, tested. If you are under 40 with a family history of heart murmurs or sudden cardiac death, consider an EKG.

Dr. Lewis Maharam, medical director for New York City Marathon, recommends that all runners over 40 have an echo or stress test to rule out heart disease.

And the best advice for runners: listen to your body. If you experience shortness of breath, chest pain or discomfort when you run, have it checked out. Don't become a marathon statistic.

Upcoming events

Saturday, 8 a.m.: Up-N-Running Group Run, Valencia. Ed's got the coffee on. 724-898-2525 or www.runpa.com

Saturday, 9:30 a.m.: Youngstown Road Runners Club Scholarship 5K, Canfield, Ohio. 330-965-2695

Saturday: Pigskin Classic 5K, Cleveland. 216-625-9933

Sunday, 9 a.m.: Cleveland Classic Half Marathon, Cleveland. 440-243-0445

Nov. 27, 8:15 a.m.: Downtown YMCA Turkey Trot, Pittsburgh. 412-227-5300 or kberger@ymcapgh.org

Nov. 27, 9 a.m.: Gobbler's Gallop, Ellwood City. Choice of 10K at 9 a.m. or 5K at 10. Also 5K noncompetitive walk anytime. 724-758-6227

Nov. 27, 9:30 a.m.: Gobble Wobble, Hermitage. Run through Buhl Park. gobblewobble@yahoo.com

Nov. 27, 9:30 a.m.: Latrobe Turkey Trot 5K, Latrobe. 724-537-4331 or jeannelpremsn.com

Nov. 28, 9 a.m.: SWIF Turkey Trot 5-Mile, North Park. Starts at boathouse. 724-444-3400

Dec. 7, 9 a.m.: Trot for Tots 5k, Oakdale. A 10K is at 9:40. New location. Please bring a new unwrapped toy for Toys for Tots. 412-490-0881 or www.eliterunners.com

Race results

Buffalo Creek Half Marathon, Oct. 18: Chris Geddis, 1st Overall M, 1:09:39; Nicole Blaeser, 1st Overall W, 1:18:45; Tim Monfre, 3rd Masters M, 1:18:15; Sharyl Relic, 2nd Masters W, 1:34:58; Matt Montellanico, 1st 20-24 M, 1:16:53; ZZ, 2nd 30-34 M, 1:21:56; Rich Makin, 2nd 50-54 M, 1:23:21; Dave Terrill, 3rd 50-54 M, 1:23:49; Lawrence Ross, 1st 55-59 M, 1:28:01; Colton Schmoll, 1st 19 and under M, 1:42:57; Maddie Spigler, 3rd 20-24 W, 1:43:38; Patricia Neubert, 1st 55-59 W, 1:45:48; Karen Bruch, 1st 50-54 W, 1:48:00; Suzanne Leonburg, 3rd 50-54 W, 1:57:47; Lou Lodovico, 1st 70 and over M, 2:00:12; Diane Brooks, 3rd 55-59 W, 2:03:31; Margretta Lutz, 1st 70 and over W, 2:10:32; Marcia Semple, 1st 60-64 W, 2:33:50Todd Roberts, 1:29:07; David Fugate, 1:30:18; Alex Fertelmes, 1:30:38; Jason Dunlap, 1:30:41; Matt Marshall, 1:31:15; Nick Radio, 1:33:55; Dean Rippe, 1:34:26; Stephen Hepler, 1:34:50; Larry Lutz, 1:35:03; Sean Dolan, 1:37:26; Bob Todd, 1:38:20; William Marsh, 1:38:52; Susan Moury, 1:39:03; Chris Cutone, 1:39:11; Bob Markovich, 1:40:21; Don Amadee, 1:41:32; Ryan Leonburg, 1:42:47; Rick Becker, 1:43:35; William Lawson, 1:44:00; Todd Trofimuk, 1:44:17; Mary Jo Sanks, 1:45:02; Stephen DiAntonio, 1:45:51; Bob Clark, 1:45:53; Gineen Jarnevich, 1:46:19; Thomas Parenti, 1:46:44; Bruce Barnes, 1:48:00; Robert Faulkner, 1:48:28Julia Murray, 1:48:35; Charles Tanner, 1:48:50; Wayne Eakin, 1:49:10; Amelia Reufthaler, 1:49:23; Rita McClelland, 1:49:39; Basil Maimone, 1:50:13; Charles Huth, 1:50:17; Heather Cianfrocco, 1:52:23; Derrick Henderson, 1:51:26; John Armstrong, 1:52:15; Patty Schmidt, 1:52:20; Mary Blom, 1:52:32; James Beck, 1:52:34; Ashley Brooks, 1:52:35; Amy Gallagher, 1:52:42; Carl Hill, 1:52:55; Paul Kirsch, 1:53:13; Jen Beachem, 1:53:14; Vicki Young, 1:55:05; Rhonda Kuminkoski, 1:55:33; Becky Schmoll, 1:55:33; Mary Morgan, 1:55:45; John Harding, 1:55:51; Cyndie DeLucia, 1:56:07; Kristen Fiorina, 1:57:46; Samantha Drohan, 1:57:46; Becki Smith, 1:58:12; Lizabeth Crawford, 1:58:35; Caitlyn Bement, 1:58:39; Ginger Markle, 2:00:16; Pete Allen, 2:01:50; Barbara Schweitzer, 2:01:53Barbara Spreng-Volak, 2:02:04; Debbie Gallagher, 2:02:10; Marydonna Ravasio, 2:02:11; Kristen Magdelinic, 2:02:15; Denise Cervenyak, 2:02:16; Amanda Rekich, 2:02:21; Jeffrey Yingling, 2:03:23; Jacki Yingling, 2:03:24; Michelle Minjock, 2:03:26; Pamela Black, 2:03:46; Alexandra Jones, 2:04:36; John Hoffman Jr., 2:04:51; Dave McFarland, 2:05:21; Patty Kitt, 2:11:25; Angelo Guaranta, 2:13:00; Lisa Myers, 2:15:52; Darla Culbertson, 2:17:15; Jennifer Cadamore, 2:18:05; Linda Ryan, 2:25:43Send comments and suggestions: Patricia Neubert, 435 Cherry Valley Rd., Saxonburg, Pa. 16056. Phone 724-352-4395. Email bigp16@connecttime.netPat Neubert is the running columnist for the Butler Eagle.