Sadly, three runners died at the Detroit Half Marathon today, as reported in The Detroit News.
Two runners collapsed and died around mile twelve, and the third shortly after finishing. All three were men, ages 26, 36, and 65. All received prompt medical attention and had defibrillators applied to them, all unsuccessfully.
In addition, a 23 year-old man died at the Baltimore Marathon last week, and two runners died at the San Jose Rock N Roll Half Marathon just a few weeks ago.
Why are apparently healthy athletes dying, and why is this a more common phenomenon recently?
A person can feel well, train for a race, but unknowingly may have heart disease. In younger athletes, those under age 40, the most common cause of sudden death during a race is a structural abnormality of the heart, such as hypertrophic cardiomyopathy, dilated cardiomyopathy, or arrhythmogenic right ventricular dysplasia. The presence of those structural abnormalities of the heart, combined with the stress of a competitive athletic event, can trigger a deadly arrhythmia. Amongst older participants, unknown coronary artery disease may be present, and could lead to a heart attack or arrhythmia that could then lead to death.
Statistically, the odds of dying while competing in a marathon range from 1 in 50,000 to 1 in 150,000.
What should an athlete do? How can we find these things before someone dies?
This is a controversial question amongst the cardiology community. I believe that everyone who wishes to compete in any type of endurance sports needs a full physical before participation. This includes a physical examination, blood pressure check, full panel of blood work including fasting cholesterol levels, and an EKG. A physician should also inquire as to whether there is family history of heart disease in any first-degree relatives.
In Italy, guidelines are even stricter. All young competitive athletes have a complete echocardiogram, or ultrasound of the heart. As you can imagine, the vast majority of these echocardiograms are normal, and thus this recommendation is quite controversial.
Despite the risk in participating in competitive athletics, I hope that these recent events will not scare people away from being active, because an active lifestyle, in spite of these risks, is far better than a sedentary lifestyle.