Cause, circumstance of sudden cardiac death in athletes vary by race
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Key takeaways:
- Nearly half of athletes who experienced sudden cardiac death had a structurally normal heart on autopsy.
- The cause of sudden cardiac death and the circumstances of their death varied by race.
A structurally normal heart was the most common finding among athletes who experienced sudden cardiac death, but the cause and circumstance of death varied significantly by the athletes’ race, researchers reported.
“A sudden death in an athlete is an uncommon but highly tragic event which appears almost paradoxical, as athletes epitomize the healthiest segment of society. Inherited and familiar cardiac conditions are the main causes of sudden death in young individuals and athletes. Studies on this matter have mainly focused on Caucasian athletes and the frequency or the causes of sudden death in athletes of other ethnicities is largely unknown,” Gherardo Finocchiaro, MD, PhD, honorary senior lecturer and consultant cardiologist in the Cardiovascular Sciences Research Centre at St. George’s, University of London, and colleagues wrote. “Our study focuses on this aspect and reveals that causes of sudden death may highly vary among athletes of different race. The circumstances of death differ significantly among various ethnicities, even looking at the same underlying cardiac condition.”
Their findings were published in the European Journal of Preventive Cardiology.
For this study, Finocchiaro and colleagues reviewed data from 848 consecutive athletes who experienced sudden cardiac death and whose whole hearts were referred postmortem to the Cardiac Risk in the Young (CRY) Centre for Cardiac Pathology at St. George’s from 1994 to November 2022. The mean age at death was 33 years, of which 86% were men and 89% were white, 6% were Black and 5% were Asian.
Athletic status was derived from information garnered from sources such as the individuals’ general practitioner or family and the circumstances of death were categorized as either during exercise or rest or sleep.
All cases underwent a full autopsy by the local pathologist, and, after exclusion of extracardiac causes of death and negative toxicology, the heart was referred for comprehensive macroscopic examination of the whole heart and histological analysis.
The most common sport in this cohort was soccer (31%), followed by running (20%), swimming (7%), daily frequenters of the gym (7%), cycling (6%) and rugby (3%).
Overall, 94% of individuals had no prior history of cardiac disease, but 12% had a family history of premature sudden cardiac death.
Race/ethnicity and cause of athlete cardiac death
Sudden arrhythmic death syndrome, indicated by a normal heart on autopsy, was the most common cause of death among the athletes (45%), followed by myocardial diseases (32%) including arrhythmogenic cardiomyopathy (15%), idiopathic left ventricular hypertrophy (7%), hypertrophic cardiomyopathy (6%) and idiopathic LV fibrosis (3%), according to the study.
Sudden arrhythmic death syndrome was similarly common among white, Black and Asian athletes who experienced sudden cardiac death, at roughly 45% of cases for each. However, cardiomyopathies were more commonly found among Black athletes (43%) compared with Asian (34%) and white athletes (31%; P = .07), and arrhythmogenic cardiomyopathy was more common among Black athletes (25%) compared with Asian (8%) and white athletes (14%; P = .03).
In contrast, idiopathic fibrosis was more common among Asian athletes (10%) compared with Black (4%) and white athletes (3%; P = .02), and CAD was more common in Asian athletes (15%) compared with white (7%; P = .06) and Black athletes (2%; P = .02).
Race/ethnicity and circumstances of athlete cardiac death
Overall, 87% of athletes died during exercise, whereas 13% died at rest, including the 5% who died during sleep.
Arrhythmogenic cardiomyopathy was more common among white individuals who died during exercise compared with those who died at rest (P = .005), but this difference did not occur in Black or Asian athletes, according to the study.
HCM was diagnosed only among Black and Asian athletes who died during exercise, and not among those who died at rest, representing 7% of Black athletes and 16% of Asian athletes who experienced exercise-induced sudden cardiac death.
“Our study provides further knowledge on of the relationship between ethnicity and causes and circumstances of sudden cardiac death in athletes. Death occurred mostly during exercise, and implementation of policies aimed at the provision of automated external defibrillators in public venues may improve prevention of these tragic events,” the researchers wrote. “A structurally normal heart at autopsy, suggesting a possible primary arrhythmia syndrome as possible cause, and cardiomyopathies were the most common findings. As these conditions are often detectable with an ECG in asymptomatic individuals, these deaths are potentially preventable.
“The burden of causes of death as well as the conditions implicated in exercise-induced sudden cardiac death vary significantly according to ethnicity. These are important elements that should drive personalized prevention in apparently healthy athletes,” they wrote.
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