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Are Competitors in Long-Distance Running Races at Increased Risk for Cardiac Arrest?
Exhaustive data from the past decade suggest that runners with no preexisting heart disease have little cause for anxiety.
As my patients know, I have been a runner for 40 years. Any research involving running usually catches my eye. This article demonstrates that yearly physicals are important. I am not a cardiologist, but I do like the idea of a stress EKG periodically.
When a news announcer reports that a runner has experienced cardiac arrest during a road race, many people become anxious about exercising. To provide much-needed perspective on the cardiac risk of participation in long-distance running races, investigators used a prospectively compiled database to assess the incidence and outcomes of cardiac arrest during and immediately after marathon and half-marathon races in the U.S. from January 2000 through May 2010. Cardiac arrest was defined as a state of unconsciousness, without spontaneous respiration and pulse, documented by a medical professional.
Of almost 11 million runners in the database, 59 experienced cardiac arrest (mean age, 42 years; 86% men), an incidence of 1 per 184,000 participants. Of those who experienced cardiac arrest, 42 (71%) died, resulting in an incidence of sudden death of 1 per 259,000 participants. Cardiac-arrest survivors were older than nonsurvivors (49 vs. 39 years; P=0.002). Of the 23 runners who died and had complete medical information, the cause of the arrest was hypertrophic cardiomyopathy in 8 and possible hypertrophic cardiomyopathy in 7. Other causes of death included hyponatremia (1), hyperthermia (1), arrhythmogenic right ventricle (1), and no evidence of abnormality (2). The strongest predictors of survival were bystander-initiated resuscitation and a cause other than hypertrophic cardiomyopathy.
Comment: Absolute rates of cardiac arrest during marathons and half-marathons are quite low, although the event is always tragic. Many of the runners in this study who suffered cardiac arrest had a cardiac abnormality that could have been identified before the event; it would therefore seem prudent to advise participants in long-distance races to undergo a cardiac examination by a physician to exclude structural cardiac abnormalities. The authors suggest that preparticipation exercise testing might also be useful. In any case, race organizers should ensure that volunteers are trained in cardiopulmonary resuscitation.