The recent death of a 38-year-old runner and the hospitalization of a 21-year-old, both in apparently good health, due to cardiorespiratory arrest during the Movistar Madrid Half Marathon has reignited the debate on whether cardiovascular incidents in sports can be prevented through pre-sports medical evaluations. What advice can primary care professionals offer individuals engaging in intense physical activity?
To address this issue, Univadis Spain, a Medscape Network platform, spoke with Leonel Diaz-Gonzalez, coordinator of the Sports Cardiology Working Group of the Spanish Society of Cardiology, and cardiology head at the High-Performance Center of the Higher Sports Council, Madrid, Spain.
Sudden Death Cases
Despite the concerns following the Madrid half-marathon, the current data do not indicate a relative increase in “the number of cases of sudden death or cardiovascular incidents during intense sports activities. The incidence remains the same at approximately 1.5 cases per 100,000 athletes. However, the growing number of participants in intense sports events has led to an absolute increase in the number of cases,” Diaz-Gonzalez explained.
However, there is no need for an alarm if no relative increase is observed. For now, “it is simply a matter of statistics: The more athletes, the higher the number of cardiovascular incidents,” he continued.
Actions for Primary Care
Although the number of deaths from sudden cardiac arrests during sports is rare, efforts should be made to reduce them. One approach is for primary care professionals to guide patients to engage in sports activities.
“It is a great idea in theory, but we must acknowledge that primary care is already overwhelmed. The limited time professionals have with patients makes it challenging to provide tailored recommendations and complementary tests based on their health status,” noted Diaz-Gonzalez.
Diaz-Gonzalez offered the following simple recommendations:
- Adopt healthy habits: Cardiovascular risk increases with poor diet, smoking, alcohol use, sleep deprivation, and being overweight.
- Avoid exercise in isolation: A sedentary lifestyle during the week followed by intense weekend sports can be harmful to health. Aim for regular and moderate exercise.
- Set realistic goals: Attempting ambitious goals, such as running a half marathon after a long period without training, is risky.
Diagnostic Tests
The type of tests needed depends on the profile of the athlete in question.
- Under 35 years old: A stress test (ECG during exercise) or a standard ECG with a cardiac ultrasound is recommended to rule out congenital conditions such as hypertrophic cardiomyopathy or anomalous origin of a coronary artery.
- Over 35 years old: A stress test or ECG, along with a medical history review, including family and personal history and health status, is advised. Risk factors such as hypertension, atherosclerosis, smoking, and obesity may require additional tests.
Mandatory Testing
The requirement for health certification depends on the country and sport. In Spain, health tests are generally not mandatory for participation in sports events.
Diaz-Gonzalez noted, “It would be ideal to conduct these tests, but in practice, it is very challenging. Stress tests are logistically complex for large-scale events. Although electrocardiograms are simpler, the challenge lies in interpreting the results. This would require a sufficient number of experienced cardiologists.”
Diaz-Gonzalez declared no conflict of interest.
This story was translated from Univadis Spain using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.