Sudden deaths in young competitive athletes are tragic events, with high public visibility. The importance of race and gender with respect to sport and the diagnosis and causes of sudden death in athletes has generated substantial interest.
Methods
The US National Registry of Sudden Death in Athletes, 1980-2011, was accessed to define the epidemiology and causes of sudden deaths in competitive athletes. A total of 2406 deaths were identified in young athletes aged 19 ± 6 years engaged in 29 diverse sports.
Results
Among the 842 athletes with autopsy-confirmed cardiovascular diagnoses, the incidence in males exceeded that in females by 6.5-fold (1:121; 691 vs 1:787,392 athlete-years; P ≤.001). Hypertrophic cardiomyopathy was the single most common cause of sudden death, occurring in 302 of 842 athletes (36%) and accounting for 39% of male sudden deaths, almost 4-fold more common than among females (11%; P ≤.001). More frequent among females were congenital coronary artery anomalies (33% vs 17% of males; P ≤.001), arrhythmogenic right ventricular cardiomyopathy (13% vs 4%; P = .002), and clinically diagnosed long QT syndrome (7% vs 1.5%; P≤.002). The cardiovascular death rate among African Americans/other minorities exceeded whites by almost 5-fold (1:12,778 vs 1:60; 746 athlete-years; P <.001), and hypertrophic cardiomyopathy was more common among African Americans/other minorities (42%) than in whites (31%; P ≤.001). Male and female basketball players were 3-fold more likely to be African American/other minorities than white.
Conclusions
Within this large forensic registry of competitive athletes, cardiovascular sudden deaths due to genetic and/or congenital heart diseases were uncommon in females and more common in African Americans/other minorities than in whites. Hypertrophic cardiomyopathy is an under-appreciated cause of sudden death in male minority athletes.
Sudden deaths in young competitive athletes are a highly visible medical and societal issue, which has attracted considerable interest in both the physician and lay communities.1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19 Most recently, substantial attention has been directed toward the interaction of race, gender, cardiac diagnosis, and sport on sudden death risk, and how these variables may influence implementation of the most effective and practical strategy for preparticipation screening to detect unsuspected and potentially lethal genetic and/or congenital cardiovascular diseases.3, 8, 9, 10, 12, 13, 14, 15, 16, 17, 18, 19 To that purpose, we have taken this opportunity to revisit these issues by accessing the largest available national forensic database, which represents a unique resource for insights into the epidemiology of sudden death events in young athletes and the underlying causes.
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-Barry J. Maron, MD, Tammy S. Haas, RN, Aneesha Ahluwalia, Caleb J. Murphy, BS, Ross F. Garberich, MSc
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This article originally appeared in the November 2016 issue of The American Journal of Medicine.
