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HCM leading cause of cardiac arrest in marathon runs

Hypertrophic cardiomyopathy and coronary artery disease main causes of cardiac arrest in marathon running

The risk of having a cardiac arrest during a marathon or half-marathon is very low, but when it happens it is usually caused by the heart muscle disease hypertrophic cardiomyopathy or coronary artery disease, a study in America has shown.

The risk has slightly risen in the past decade, but this is likely to be caused by older, less fit runners taking part, the study of 11 million race entries from January 2000 to May 2010 has shown.

Men faced a greater risk than women, and full marathons were more dangerous than half-marathons. In all, there were 59 cases of cardiac arrests – 42 of them fatal – during the races or within an hour afterwards.

Senior researcher Dr Aaron Baggish, from Massachusetts General Hospital, said the increase in the number of cardiac arrests could be due to the change in the demographic, of men in particular, turning to marathons over the last 10 years."

Instead of only healthy fit athletes doing marathons, there were now more older people who had previously been sedentary and had some risk factors.

But he said: "Being a runner is one of the best ways to stay healthy and reduce your risk of disease. But it's not 100 per cent protective," he said.

He said the figures gave a risk of 1 in 184,000 runners having a cardiac arrest during or just after a run. The risk of sudden death was 1 in 259,000, which the researchers characterised as "a low overall risk."

The average age at cardiac arrest was 42, plus or minus 13 years. The fatal cases tended to be among younger runners and those who were not given CPR straight away.

Doctors needed to be aware that 50-year-old runners who covered 15 miles a day can have some of the same risk factors as their couch-potato contemporaries.

The rate of 10.1 cardiac arrests per million entrants in full marathons (26 miles) was nearly four times higher than the rate of 2.7 per million for half marathons. The rate of death during full marathons was more than twice as high.

The risk of cardiac arrest was more than five times higher for men than women (9.0 per versus 1.6 per million entrants).

Among the 59 runners with cardiac arrest, the cause was only available for 31, including 23 who died. Fifteen deaths were blamed on hypertrophic cardiomyopathy or possible hypertrophic cardiomyopathy. Among the eight who didn't die, five apparently had cardiac arrest from ischaemic heart disease, yet none of the five had evidence of plaque rupture or thrombus.

The results from the Race Associated Cardiac Arrest Even Registry (RACER) Study Group are similar to a 1996 analysis of more than 200,000 marathon runners done at the Minneapolis Heart Institute Foundation, which showed the risk of sudden cardiac arrest while running a marathon was 0.002%.

Dr Baggish concluded: “One of the big take-homes is that marathon running is safe and appears to be very well tolerated.

"As doctors are seeing more and more people who are doing these events or are interested in becoming runners, it's paramount that they think about whether these patients have an increased risk based on genetics, like with hypertrophic cardiomyopathy, or an acquired condition such as coronary artery disease."

For patients, similar advice held. He recommended a discussion with their doctor about their own individual risk factors to ensure they were not at any increased risk.

by CMA Manager on 13-Jan-12 11:10

TheCardiomyopathyAssociation

HCM leading cause of cardiac arrest in marathon runs

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