Sudden cardiac death in athletes: incidence, causes, and trends over 20 years

Although the incidence of sudden cardiac death (SCD) among American college athletes has decreased in the last 20 years, a significantly higher rate was observed in certain subgroups. Male basketball and male football players appeared to have the highest risk of SCD, according to the findings of a large observational study.

Dr Bradley Petek (Oregon Health and Science University, OR, USA) and co-investigators conducted a study to explore the incidence and causes of SCD among National Collegiate Athletic Association (NCAA) athletes [1]. The retrospective/prospective cohort study ran for 20 years (from 2002 through 2022) and registered over 9 million years of athletic participation.

Over those 20 years, 1,102 athletes died and 143 of these cases were reported as SCDs. The average age of those who died due to SCD was 20 years, 83% of them were men, 59% were White, and 36% were Black. Also, most SCD cases were division 1 athletes (45%), whereas 29% and 26% of the SCD cases were participating in division 2 and 3, respectively. In terms of sports, the highest absolute numbers of SCD cases were seen among American football players (30%), basketball players (25%), and track-and-field athletes (13%).

The overall incidence of SCD was 1 case in 63,682 athlete-years. The risk of SCD appeared to be higher among men, with 1 case in 43,348 athlete-years. This risk was 1 case in 164,504 athlete-years among women. Furthermore, the incidence of SCD was higher among Black athletes than among White athletes, with 1 case per 27,217 athlete-years and 1 case per 74,581 athlete-years, respectively. Next, division 1 and 2 athletes may be at higher risk, with approximately 1 case of SCD per 50,000 athlete-years compared with 1 case in 95,313 athlete-years in division 3 athletes. The highest rates were found among basketball players (1 per 19,164 athlete-years) and American football players (1 per 31,743 athlete-years).

“It becomes even more interesting when we look at the individual levels,” expressed Dr Petek. The incidence of SCD was 1 per 5,848 athlete-years among division 1 basketball players who were men and White and 1 per 7,696 athlete-years among division 1 basketball players who were men and Black. Among women athletes, the highest incidence rates were observed among division 2 track-and-field athletes who were Black (1 per 24,942 athlete-years) and division 2 basketball players who were Black (1 per 30,880 athlete-years). “When we looked at SCD over the 20-year timeframe, there was a decrease in SCD with a 5-year IRR of 0.71 (95% CI 0.61–0.82),” noted Dr Petek. He further outlined that autopsy-negative sudden unexplained death (19.5%), idiopathic left ventricular hypertrophy/possible cardiomyopathy (16.9%), and hypertrophic cardiomyopathy (12.7%) were the most common causes of SCD. Finally, Dr Petek mentioned the exertional status at the time of SCD for the various causes of SCD (see Figure).

Figure: Exertional status at the time of SCD [1]

AN-SUD, autopsy-negative sudden unexplained death; CM, cardiomyopathy; NOS, nitric oxide synthases; SCD, sudden cardiac death.

“Continual efforts to improve cardiopulmonary resuscitation training, AED access, emergency action planning, and pre-participation cardiovascular screening are imperative to improve outcomes,” Dr Petek concluded.

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   1. Petek B, et al. Incidence and causes of sudden cardiac death in NCAA athletes: a 20-year study. FS06, AHA Scientific Sessions 2023, 11–13 November, Philadelphia, USA.

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Posted on 29 January 202429 January 2024