Sudden death in athletes: Preventable or inevitable?

Abstract

Sudden cardiac death (SCD) is a tragic and devastating complication of a number of underlying cardiovascular diseases. In people younger than 35 years, genetic heart diseases such as inherited cardiomyopathies, namely, hypertrophic cardiomyopathy (HCM), and primary arrhythmogenic disorders, including familial long QT syndrome, represent an important cause of SCD. In those younger than 35 years, coronary artery disease and myocardial infarction together comprise over 90% of SCD cases. Understanding the causes and arrhythmogenic substrates underpinning SCD and elucidating what specific factors may trigger malignant arrhythmias represent key foundations for the development of treatment and prevention strategies to reduce SCD in our communities. In this issue of HeartRhythm, Risgaard et al present findings from a retrospective nationwide study of SCD in Denmark, with data from SCD cases collected over a 3-year period from 2007 to 2009. The main focus was on SCD cases aged 12–49 years and specifically to compare SCD incidence rates between competitive and noncompetitive athletes, so-called sports-related SCD cases. Of 881 SCD cases aged 12–49 years over the study period, 44 sports-related SCD cases were identified (0.54 per 100,000 person-years). Significantly, in the age group of 12–35 years, there was no difference in the incidence of SCD between competitive (0.47 per 100,000 athlete person-years) and noncompetitive (0.43 per 100,000 athlete person-years) athletes. The incidence of sports-related SCD in those aged 36–49 years was significantly increased in both competitive and noncompetitive athletes. Importantly, the overall incidence of SCD in the general population was found to be much more prevalent than that of sports-related SCD in all age groups. The authors are to be congratulated for the rigorous and dedicated efforts to collect this important data set. These