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 A study of more than 9 million participants over three decades found
that deaths and cardiac arrests struck 1.74 out of every 100,000
competitors.
The risk associated with a single triathlon was higher than the
annual risk of death for a middle-aged adult in the general
population, and also exceeds previous estimates for long-distance
running races, including marathons, researchers report in the Annals
of Internal Medicine.
“The majority of deaths occur in the swim portion of the triathlon,
which is the first portion of the race,” said lead study author Dr.
Kevin Harris, a cardiologist at Minneapolis Heart Institute
Foundation at Abbott-Northwestern hospital in Minnesota.
“During this portion of the race, the athletes likely experience an
adrenaline surge as they enter the water and are competing in close
proximity to other athletes, and in some cases with environmental
conditions that are difficult to prepare for,” Harris said by email.
“We don’t understand the exact cause of death in each athlete, and
some swim deaths may be related to drowning.”
Since its origin in the 1970s, the triathlon has become an
increasingly popular endurance activity worldwide. A standard
Olympic triathlon involves a 1.5 kilometer (0.9 mile) swim, followed
by a 40 kilometer (24.8 mile) bike ride and a 10 kilometer (6.2
mile) run.
For the study, researchers examined data on triathlon participants
from 1985 to 2016.
During the study period, 135 people died suddenly or had a cardiac
arrest. This included 107 sudden deaths as well as 13 race-related
cardiac arrests that people survived because of prompt emergency
medical attention.
The victims were 47 years old on average, and 85 percent were male.
Overall, 90 deaths and cardiac arrests occurred during the swimming
portion of races, while 7 happened during cycling, 15 occurred while
running and 9 happened during the recovery period right after the
race.
During the cycling segment, there were also 15 trauma-related deaths
involving crashes or other accidents.
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Autopsy data showed that clinically silent cardiovascular disease
was present in an unexpected proportion of decedents, suggesting a
need for participants to know their risk before racing.
The incidence of cardiovascular events was strikingly lower in
female triathletes, 3.5-fold less than in men.
Death risks also increased with age. Among men 60 and older, 19
participants died or suffered cardiac arrest out of every 100,000
competitors.
One limitation of the study is that researchers used race finishers
in their estimates, which might underestimate the risks associated
with triathlons, the authors note.
Even so, the results should serve as a reminder to participants to
make sure they are medically fit to compete in these endurance
races, said Dr. Reginald Ho, author of an accompanying editorial and
a professor of medicine at Sidney Kimmel Medical College of Thomas
Jefferson University Hospital in Philadelphia.
“They should see their physician regularly for health checks that
include a complete history and physical examination,” Ho said by
email. “Any heart-related symptoms (chest tightness, heaviness or
discomfort, shortness of breath, palpitations, lightheadedness,
passing out episodes) should be reported to their doctor.”
The study results, however, shouldn’t overshadow the many health
benefits of exercise or dissuade otherwise healthy people from
considering endurance races, said Hannah Arem, a researcher at the
George Washington Milken Institute School of Public Health in
Washington, D.C., who wasn’t involved in the study.
“For the majority of individuals, engaging in regular exercise will
yield more benefit than harm,” Arem said by email.
SOURCE: http://bit.ly/2wYH0qu Annals of Internal Medicine, online
September 18, 2017.
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