The Heart of the Matter

We’re triathletes. So we’re healthy, right?

Well, that’s probably true — particularly if we compare ourselves to our friends or family members who are sitting on the couch watching the TV while we’re out swimming, biking or running. And in fact, the health benefits of regular exercise are well documented: decreased risk of many forms of heart disease, better weight control, better mood, improved sleep quality, decreased risk of colon or breast cancer, decreased risk of osteoporosis. The list is long.

That said, there’s also some undeniable risk associated with participation in endurance athletics like triathlon. We know about the possibility of bicycle accidents and injury. And we know (all too well) the myriad of overuse injuries that may occur. But today let’s consider the heart-related risk that comes with triathlon, and in particular the possibility of heart-related sudden death during competition.

Accounts of sudden death during athletic training or competition produce sensational news reports, but these events are rare. Thankfully, there are only a handful of sudden deaths in the United States each year during marathon races or triathlons.

Despite the increasing popularity of triathlon, the issue of sudden death during triathlon races is not well understood. In the only study of its kind, Dr. Kevin Harris and his colleagues at the Minneapolis Heart Institute recently studied the issue of sudden deaths that occur during triathlons and reported their findings at last year’s annual meeting of the American College of Cardiology. They reviewed 2,846 triathlon events sanctioned by USA Triathlon that were held from 2006 to 2008. These events included sprint, intermediate and long-course events in which 922,810 athletes participated.

There were 14 deaths; 13 of which occurred during the swim portion of the event. This works out to about 1.5 deaths per 100,000 participants, nearly twice the reported rate of sudden death during marathon running events. The age of the victims ranged from 28 to 55 years and 11 of 14 deaths occurred in men. The rate of sudden death was not related to the race distance. Autopsies were conducted on six of the victims and four were found to have structural heart disease that was likely responsible for their death. The other two autopsies were normal, suggesting that an arrhythmia (abnormal heartbeat) caused the death. Sadly, each of the victims probably appeared to be the picture of good health when they toed the line at the start. But perhaps these deaths could have been prevented. That’s the real opportunity here.

So, I hope I’ve got your attention. Sudden death in “healthy” athletes ought to get your attention. But this is just one of many heart-related issues that confront endurance athletes. I’ll be back each month to talk about these issues, trying to relate them to the typical triathlete. We’ll talk about issues like blood pressure, arrhythmias, blood cholesterol/lipids, coronary artery disease, heart valve problems and arterial disease, among others. Together, we’ll work toward becoming more knowledgeable about these issues, enabling you to take better charge of your own cardiovascular health, and leaving you in a position to be vigilant for the signs and symptoms of heart disease and seek appropriate treatment when needed.

As we go along, I’d welcome your comments and suggestions and I’d be particularly happy if we could share some personal stories and generate some discussion.