Young Athletes May Be More Prone To Sudden Death Than Non-Athletes; Enhanced Screening Urged

This data shouldn’t discourage young people from participating in sports; rather, it should point to the need for more extensive screening methods for young athletes, says study author Domenico Corrado, M.D., consultant of clinical cardiology and electrophysiology at the University of Padova Medical School in Padova, Italy.

“In young people, cardiovascular diseases that usually are silent account for a higher risk of sudden death during sports,” he says. “Pre-participation screening is important in identifying the athletes affected by these potentially lethal conditions.”

To establish the effect of sports activity on the risk of SD, researchers investigated the incidence of fatal events in the athletic and non-athletic populations, ages 12 to 35, in the Veneto region of Italy from 1979 to 1999. All athletes in Italy of these ages undergo mandatory sports screenings, including personal and family history and a 12-lead electrocardiogram (ECG).

Three hundred sudden deaths in young people were recorded during this period, representing 1 per 100,000 per year in this age group. Among athletes, the rate of sudden death was 2.3 per 100,000 compared with 0.9 per 100,000 for non-athletes. There were more deaths among non-athletes (245) versus athletes (55), but the non-athlete group is much larger than the athlete group, Corrado says. The estimated risk of sudden death was 2.5 times higher in athletes.

The relative risk of SD among athletes versus non-athletes was 1.95 for males and 2.02 for females.

The study also identified the conditions most likely to cause SD in younger athletes, including anomalous coronary artery origin (a congenital heart abnormality in the coronary artery) and arrhythmogenic right ventricular cardiomyopathy (a heart muscle disease that predisposes people to deadly irregular heart rhythms). The relative risk of sudden death due to anomalous origin of the coronary artery was 78.4 times higher in athletes than in non-athletes. The relative risk for sudden death due to arrhythmogenic right ventricular cardiomyopathy was 5.5 higher in athletes compared with non-athletes.

The researchers note that one of the major causes of SD in young athletes in the United States didn’t show up as much in the Italian population – hypertrophic cardiomyopathy, an excessive thickening of the heart muscle. A U.S. study indicated that 36 percent of 158 athletes (median age 17) who died of sudden cardiac death from 1985 to 1995 had probable or definite hypertrophic cardiomyopathy. This discrepancy could be due to the Italian protocol for pre-participation sports screenings that includes an ECG, which identifies those at risk for hypertrophic cardiomyopathy, Corrado says.

Corrado believes the addition of the pre-participation ECG testing is beneficial for younger athletes because it is especially sensitive for identifying heart abnormalities.

American Heart Association spokesman Gerald Fletcher, M.D., says the study provides important new data, but an ECG has limited value in young people.

“In hypertrophic cardiomyopathy, the ECG may not reveal changes in 10 percent or more of cases and in those that do the changes may be unclear,” says Fletcher.

The American Heart Association’s position on pre-participation screening emphasizes a careful personal and family history and physical examination. If data suggests a potential cardiac problem, the physician may recommend further testing. That may include an ECG, echocardiogram or exercise stress testing, says Fletcher.

Other authors of the study are: Cristina Basso, M.D.; Giulio Rizzoli, M.D.; and Gaetano Thiene, M.D.