A study published in 1996 found that the risk of having a fatal heart attack during, or in the period 24 hours after a marathon, was approximately 1 in 50,000 over an athlete's racing career—which the authors characterised as an "extremely small" risk. The paper went on to say that since the risk was so small, cardiac screening programs for marathons were not warranted. However, this study was not an attempt to assess the overall benefit or risk to cardiac health of marathon running.

In 2006, a study of 60 non-elite marathon participants tested runners for certain proteins (see Troponin) which indicate heart damage or dysfunction after they had completed the marathon, and gave them ultrasound scans before and after the race. The study revealed that, in that sample of 60 people, runners who had done less than 35 miles per week training before the race were most likely to show some heart damage or dysfunction, while runners who had done more than 45 miles per week training beforehand showed few or no heart problems.

In 2007, Ryan Shay, a 28 year-old elite long-distance runner, died after collapsing early in the US Olympic marathon trials. His death was reported as probably due to a pre-existing heart abnormality.

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