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Elite endurance sports: the safety debate runs on but new study finds 41% lower mortality rate among French Tour de France riders 

ESC Congress News 2013 - Amsterdam

Topics: Acute Coronary Syndromes (ACS)
Date: 04 Sep 2013
The persistent dilemma over the effects of elite endurance sports on cardiovascular risk and mortality has been somewhat resolved by a remarkable study of French participants in the world’s greatest sporting event.

The Tour de France, this year celebrating its 100th event and ‘one of the most physiologically demanding sports competitions’. A mortality study of postwar French participants estimated a six-year greater longevity than in the general male population.

The Tour de France, said the investigators, whose study was presented in a Hot Line session yesterday and reported online in the European Heart Journal, is ‘one of the most physiologically demanding sports competitions’. The effort required just to finish the race, said investigator Xavier Jouven from the Sudden Death Centre of Expertise in Paris,  has been compared to running  a marathon several days a week for three weeks,  or climbing three Everests.
Yesterday’s study analysed the cause of death of every deceased French cyclist to take part in the Tour since 1947 - that is, 208 elite cyclists from a total of 786.  
The immediate and notable finding of the study was a ‘substantial and significant’ lower mortality rate among the French riders than among their counterparts in the French population,  a ‘huge’ 41% lower rate which did not change over time or according to cause of death (neoplasms 32%, CVDs 29% and others). This lower rate corresponded to an additional longevity of about six years.
Investigator Xavier Jouven
Jouven said the results were of particular interest within the controversial context of regular strenuous exercise and its possible deleterious effects. ‘We tend to be cautious in terms of public health,’ he said. ‘We don’t really know to what upper level  people can take their exercise. So we are often afraid of very high levels.
‘However, in our results here we are not able to distinguish between the positive and negative effects of high level sports activity. So we can’t deliver a strong public message. But I think  it’s fair to say that if there was a danger in an event like the Tour, we would have seen it.’
Jouven readily acknowledged at least two caveats to his study. First, the degree of fitness and ability required to even participate in the Tour is exceptional. This must, said Jouven, impose a selection bias on the study. Moreover, it seems unlikely that these superfit cyclists will have abandoned their healthy lifestyles once their professional careers are over.
The second caveat is the ever-present spectre of doping, which say the investigators, has gone through three recent phases: amphetamines in the 1950-60s; anabolic steroids in the 1970-80s; and since 1990 EPO (to which seven-times Tour ‘winner’ Lance Armstrong admitted earlier this year). And doping too ‘may have attenuated the association between participation in the Tour de France and lower long-term mortality’.
However, that reduction in mortality was real and significant, and reason enough for Jouven to be upbeat about the study’s implications. ‘We usually advise caution with high level sports,’ he said, ‘but that message is wrong. We should encourage exercise. The positive effects seem greater than the negative.’

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About the European Society of Cardiology
The European Society of Cardiology (ESC) represents more than 80,000 cardiology professionals across Europe and the Mediterranean. Its mission is to reduce the burden of cardiovascular disease in Europe.

About ESC Congress 2013
The ESC Congress is currently the world’s premier conference on the science, management and prevention of cardiovascular disease.  The spotlight of this year's event is “The Heart Interacting with Systemic Organs”.  ESC Congress 2013 takes place from 31 August to 4 September at the RAI centre in Amsterdam, Netherlands. More information on the scientific programme.


Refers to session:  Hot Line IV: Late Breaking Trials on Heart Failure and Acute Coronary Syndrome