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Risk for cardiac arrest low among marathon runners
Kim JH. N Engl J Med. 2012;366:130-140.
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People who participate in marathons and half-marathons appear to have a low overall risk for cardiac arrest and sudden death, according to researchers from Massachusetts General Hospital and Harvard Medical School.
CVD was responsible for most cardiac arrests, which were more common among men, the researchers concluded.
The study included those who ran marathon and half-marathon races from January 2000 to May 2010. The researchers identified instances of cardiac arrest that occurred during the running or at the finish-line recovery area within 1 hour after completion of the race. Letters about the study were sent to the survivors or the next of kin of nonsurvivors. Participants filled out a questionnaire that addressed the runner’s history of running and exercise, medical history and information about the cardiac arrest.
Among the 10.9 million runners, 59 cardiac arrests were identified, 40 in marathons and 19 in half-marathons. The overall incidence of cardiac arrest was 0.54/100,000 participants. The incidence during marathons was 1.01/100,000 participants, which was higher than the incidence of 0.27/100,000 participants for half-marathons (P< .001). The incidence rate also was higher in men than in women: 0.9/100,000 for men vs. 0.16/100,000 for women (P< .001).
The incidence of cardiac arrest among men also increased throughout the study period. From 2000 to 2004, the incidence rate of cardiac arrests was 0.71/100,000 vs. an incidence rate of 2.03/100,000 for 2005 to 2010. Of the 59 runners with cardiac arrest, 42 died. The incidence of death was higher during marathons compared with half-marathons.
Among the 31 runners with complete medical data, 23 had died. The cause of death was hypertrophic cardiomyopathy in eight runners and possible hypertrophic cardiomyopathy in seven runners. Among the survivors with medical data, ischemic heart disease was the predominant cause of death.
“Findings from the RACER initiative indicate that marathons and half-marathons are associated with a low overall risk of cardiac death or sudden death,” the researchers wrote. “However, event rates have risen over the past decade among male marathon runners. Clinicians evaluating potential race participants should be aware of the risks of hypertrophic cardiomyopathy and atherosclerotic disease in this patient population.”
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