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Prior myocardial infarction is the major risk factor associated with sudden cardiac death during downhill skiing
M Burtscher1, O Pachinger, M A Mittleman
1Department of Sport Science, University of Innsbruck, Austria. Martin.Burtscher@uibk.ac.at
Insights
Sudden cardiac deaths during downhill skiing disproportionately affect older men. Key risk factors include prior heart attack, hypertension, and lack of exercise adaptation, highlighting the need for risk assessment in skiers.
Area of Science:
- Cardiology
- Sports Medicine
- Epidemiology
Background:
- Sudden cardiac death (SCD) during downhill skiing predominantly affects men over 34.
- Limited data exist on specific risk factors and triggers for SCD in this population.
Purpose of the Study:
- To compare risk factor profiles of males who died from SCD during downhill skiing with matched controls.
- To identify specific risk factors and triggers associated with SCD in downhill skiers.
Main Methods:
- Retrospective case-control study comparing 68 male skiers with SCD to 204 matched controls.
- Analysis of risk factors including prior myocardial infarction, hypertension, known coronary heart disease, and exercise engagement.
Main Results:
- SCD skiers had significantly higher rates of prior myocardial infarction (41% vs. 1.5%), hypertension (50% vs. 17%), and known coronary heart disease (9% vs. 3%).
- SCD skiers were less engaged in strenuous exercise (4% vs. 15%).
- Multivariate analyses confirmed the significance of these risk factors.
Conclusions:
- Downhill skiing is a significant trigger for SCD, particularly in individuals with a history of myocardial infarction, hypertension, or known coronary heart disease.
- Insufficient adaptation to strenuous exercise is also a risk factor.
- Increased sympathetic activity during skiing may precipitate arrhythmias or cardiac events. Risk stratification and potential interventions or skiing abstinence are recommended for high-risk individuals.
Abstract:
More than 90% of all sudden cardiac deaths (SCDs) during downhill skiing, the most popular winter sport world-wide, are attributed to men over the age of 34. However, no data exist on additional risk factors and triggers for SCD related to downhill skiing. Therefore risk factor profiles of 68 males who died from SCD during downhill skiing were compared to those of 204 matched controls. Skiers who suffered SCD had much more frequently prior myocardial infarction (MI) (41% vs. 1.5%; p<0.001), hypertension (50% vs. 17%; p<0.001), known coronary heart disease (CHD) without prior MI (9% vs. 3%; p=0.05) and were less engaged in strenuous exercise (4% vs. 15%; p<0.05) when compared to controls. Multivariate analyses even enhanced the importance of these risk factors. Downhill skiing is considered to be a serious trigger for SCD especially in skiers with prior MI but also for those with hypertension, known CHD without prior MI, or insufficient adaptation to strenuous exercise. Skiing-related increased sympathetic activity might well disturb the autonomic balance with subsequent arrhythmias and/or may increase cardiac work and platelet aggregability with possible plaque rupture and coronary thrombosis. Therefore adaptation to high intensity exercise and therapeutic interventions or abstinence from skiing in certain cases should be considered for downhill skiers at high risk.