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Participation in long-distance races is associated with low risk for cardiac arrest

Comment by Erik Solberg, EACPR Sports Cardiology Section

Cardiac Arrest during Long-Distance Running Races
J.H. Kim et al.
N Engl J Med 2012; 366: 130–14


We have all noticed dramatic images from instances of cardiac arrest during mass competitive running events raising concern about the health risk of such long races.

A large American register-based study, surveying about 11 million participants in marathon and half-marathon races, defined the prevalence of such events during long-distance running.
The overall incidence rate of cardiac arrest was low, 0,54/100.000 participants. The rate was increasing in the latter part of the study period, maybe because of increased number of (high-risk?) participants in this period.
Most events (86 %) occurred in men, mean age 42 years, more frequently during marathon, and most often during the last quartile of the race. Of 59 cardiac arrests, 42 were fatal. Examining 31 cases thoroughly, hypertrophic cardiomyopathy was most common.
Contrary to previous understanding, plaque rupture was uncommon, although exercise-induced ischemia was prevalent.
This suggests that exercise testing prior to the race may be appropriate for a selected high-risk group.

The risk of running long races is comparable to other kind of sports. Clinicians should especially be aware and screen for possible cardiomyopathies and ischemic diseases among those planning to participate.