Screening Those with the Lowest Cardiovascular Mortality?

Abstract

Maron et al's analysis1Maron B.J. Haas T.S. Ahluwalia A. Murphy C.J. Garberich R.F. Demographics and epidemiology of sudden deaths in young competitive athletes: from the United States National Registry.Am J Med. 2016; 129: 1170-1177Abstract Full Text Full Text PDF PubMed Scopus (160) Google Scholar of sudden deaths in young competitive athletes deserves comments. First, they repeatedly cited the publications (see 2, 7, and 9 in their article1Maron B.J. Haas T.S. Ahluwalia A. Murphy C.J. Garberich R.F. Demographics and epidemiology of sudden deaths in young competitive athletes: from the United States National Registry.Am J Med. 2016; 129: 1170-1177Abstract Full Text Full Text PDF PubMed Scopus (160) Google Scholar) of the Italian researchers but should have warned that the reliability of their main study has always been under scrutiny: Repeated requests for data to the Italian researchers remained unanswered, even a formal one from the Secretary of State for Health for England to the Italian Minister of Health.2Cohen D. Data on benefits of screening for sudden cardiac death are withheld.BMJ. 2016; 353: i2208Crossref PubMed Scopus (4) Google Scholar Second, they support the American Heart Association/American College of Cardiology recommendation of preparticipation screening but should have warned of a basic flaw: the lack of the rating quality of its evidence and its strength. Health checks and screening, as all prescriptions, should be evidence based on relevant clinical outcomes. There is no robust evidence for clinical benefit (reduced morbidity or mortality). Screening can be a waste of resources and can expose people to harmful consequences of overdiagnosis. Independent organizations, such as the Belgian Health Care Knowledge Centre, do not recommend preparticipation screening.3Van Brabandt H. Desomer A. Gerkens S. Neyt M. Preparticipation screening for the prevention of sudden cardiac death in young non-professional athletes: harms outweigh benefits.BMJ. 2016; 352: i1156Crossref Scopus (38) Google Scholar Moreover, athletes show a considerably lower all-cause and cardiovascular diseases–related standard mortality ratios than the general population.4Garatachea N. Santos-Lozano A. Sanchis-Gomar F. et al.Elite athletes live longer than the general population: a meta-analysis.Mayo Clin Proc. 2014; 89: 1195-1200Abstract Full Text Full Text PDF PubMed Scopus (113) Google Scholar Accordingly, there are no adequate prerequisites to target them for systematic screening! Sudden cardiac death in a young seemingly healthy athlete is a tragic event, but emotion should not replace evidence. Third, could Maron et al1Maron B.J. Haas T.S. Ahluwalia A. Murphy C.J. Garberich R.F. Demographics and epidemiology of sudden deaths in young competitive athletes: from the United States National Registry.Am J Med. 2016; 129: 1170-1177Abstract Full Text Full Text PDF PubMed Scopus (160) Google Scholar provide the percentage of their 842 selected cases of genetic or congenital heart diseases fully investigated for drugs increasing left ventricular wall thicknesses (eg, cocaine and anabolic steroids) and medicines increasing QT (eg, antidepressant)? The “Materials and Methods” section should have detailed the forensic toxicologic analysis. This issue deserves a strong scrutiny.5Eichner E.R. Ergolytic drugs in medicine and sports.Am J Med. 1993; 94: 205-211Abstract Full Text PDF PubMed Scopus (31) Google Scholar Last, association does not mean causality. Increased left ventricular wall thicknesses is found routinely in elite resistance-trained athletes.6Dickerman R.D. Schaller F. McConathy W.J. Left ventricular wall thickening does occur in elite power athletes with or without anabolic steroid use.Cardiology. 1998; 90: 145-148Crossref PubMed Scopus (61) Google Scholar The ReplyThe American Journal of MedicineVol. 130Issue 8PreviewI wish to respectfully respond to the Letter to the Editor submitted by Alain Braillon. However, it is a highly unusual communication in some respects. Braillon has taken this opportunity to once again cast aspersions on the work of Italian investigators in Padua who have published repeatedly on sudden death in young competitive athletes within the mandatory national cardiovascular screening program (which routinely utilizes 12-lead electrocardiograms) in that country.1 Braillon essentially seems to be accusing the Padua group of scientific misconduct, or at least of gross incompetence. Full-Text PDF