Sudden Cardiac Death Risk in Downhill Skiers and Mountain Hikers and Specific Prevention Strategies.

Josef Niebauer,Martin Burtscher

doi:10.3390/ijerph18041621

Abstract

Sudden cardiac death (SCD) still represents an unanticipated and catastrophic event eliciting from cardiac causes. SCD is the leading cause of non-traumatic deaths during downhill skiing and mountain hiking, related to the fact that these sports are very popular among elderly people. Annually, more than 40 million downhill skiers and mountain hikers/climbers visit mountainous regions of the Alps, including an increasing number of individuals with pre-existing chronic diseases. Data sets from two previously published case-control studies have been used to draw comparisons between the SCD risk of skiers and hikers. Data of interest included demographic variables, cardiovascular risk factors, medical history, physical activity, and additional symptoms and circumstances of sudden death for cases. To establish a potential connection between the SCD risk and sport-specific physical strain, data on cardiorespiratory responses to downhill skiing and mountain hiking, assessed in middle-aged men and women, have been included. It was demonstrated that previous myocardial infarction (MI) (odds ratio; 95% CI: 92.8; 22.8–379.1; p < 0.001) and systemic hypertension (9.0; 4.0–20.6; p < 0.001) were predominant risk factors for SCD in skiers, but previous MI (10.9; 3.8–30.9; p < 0.001) and metabolic disorders like hypercholesterolemia (3.4; 2.2–5.2; p < 0.001) and diabetes (7.4; 1.6–34.3; p < 0.001) in hikers. More weekly high-intensity exercise was protective in skiers (0.17; 0.04–0.74; p = 0.02), while larger amounts of mountain sports activities per year were protective in hikers (0.23; 0.1–0.4; <0.001). In conclusion, previous MI history represents the most important risk factor for SCD in recreational skiers and hikers as well, and adaptation to high-intensity exercise is especially important to prevent SCD in skiers. Moreover, the presented differences in risk factor patterns for SCDs and discussed requirements for physical fitness in skiers and hikers will help physicians to provide specifically targeted advice.

Highlights

Mountain sport activities are becoming more and more popular all over the world.Annually, more than 10 million tourists are attracted by the mountainous areas of Austria alone, 40 million for the Alps in total and 100 million worldwide [1]
Whereas participation in regular sports activities is associated with considerable health benefits, especially vigorous exercise in unaccustomed individuals may sever as trigger for injury, illness or even sudden death [2,3]
About 50% of all Sudden cardiac death (SCD) recorded occurred on the first day of downhill skiing or mountain hiking

Summary

Introduction

Mountain sport activities are becoming more and more popular all over the world. More than 10 million tourists are attracted by the mountainous areas of Austria alone, 40 million for the Alps in total and 100 million worldwide [1]. Whereas participation in regular sports activities is associated with considerable health benefits, especially vigorous exercise in unaccustomed individuals may sever as trigger for injury, illness or even sudden death [2,3]. The risk–benefit ratio, depends on the risks associated with the specific sport activity. Mountain sports possess inherent risks due to objective hazards like rock and ice falls, avalanches, lightnings, etc. Related to subjective reasons like inflated self-esteem, insufficient sport-specific skills and/or physical fitness [5,6]. The level of individual physical fitness needs to be much higher for uphill walking

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