Clinical research: cardiac electrophysiology
Does sports activity enhance the risk of sudden death in adolescents and young adults?

https://doi.org/10.1016/j.jacc.2003.03.002Get rights and content
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Abstract

Objectives

We sought to assess the risk of sudden death (SD) in both male and female athletes age 12 to 35 years.

Background

Little is known about the risk of SD in adolescents and young adults engaged in sports.

Methods

We did a 21-year prospective cohort study of all young people of the Veneto Region of Italy. From 1979 to 1999, the total population of adolescents and young adults averaged 1,386,600 (692,100 males and 694,500 females), of which 112,790 (90,690 males and 22,100 females) were competitive athletes. An analysis by gender of risk of SD and underlying pathologic substrates was performed in the athletic and non-athletic populations.

Results

There were 300 cases of SD, producing an overall cohort incidence rate of 1 in 100,000 persons per year. Fifty-five SDs occurred among athletes (2.3 in 100,000 per year) and 245 among non-athletes (0.9 in 100,000 per year), with an estimated relative risk (RR) of 2.5 (95% confidence interval [CI] 1.8 to 3.4; p < 0.0001). The RR of SD among athletes versus non-athletes was 1.95 (CI 1.3 to 2.6; p = 0.0001) for males and 2.00 (CI 0.6 to 4.9; p = 0.15) for females. The higher risk of SD in athletes was strongly related to underlying cardiovascular diseases such as congenital coronary artery anomaly (RR 79, CI 10 to 3,564; p < 0.0001), arrhythmogenic right ventricular cardiomyopathy (RR 5.4, CI 2.5 to 11.2; p < 0.0001), and premature coronary artery disease (RR 2.6, CI 1.2 to 5.1; p = 0.008).

Conclusions

Sports activity in adolescents and young adults was associated with an increased risk of SD, both in males and females. Sports, per se, was not a cause of the enhanced mortality, but it triggered SD in those athletes who were affected by cardiovascular conditions predisposing to life-threatening ventricular arrhythmias during physical exercise.

Abbreviations

ARVC
arrhythmogenic right ventricular cardiomyopathy
CAD
coronary artery disease
CCA
congenital coronary artery anomaly
CI
confidence interval
HCM
hypertrophic cardiomyopathy
RR
relative risk
SD
sudden death

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This study was supported by the Veneto Region, Venice; Ministry of Health, Rome; and European Commission Contract QLG1-CT-2000-01091.