1. Cardiac arrest or death occurring during triathlons are not uncommon, and most of these incidences have happened in men who were middle-aged or older.
2. Most sudden deaths occurred during the swim portion of the triathlon, and asymptomatic cardiovascular disease was present in 44% of cases with an available autopsy report.
Evidence Rating Level: 4 (Below Average)
Study Rundown: The triathlon is a popular endurance sport, but race-related deaths have raised concerns about the safety of competing triathletes. In order to define the public health effects of triathlons, researchers analyzed race-related mortalities and cardiac arrests taking place during triathlons occurring between 1985 and 2016 in the United States. In this case series, researchers found a combined 135 deaths and cardiac arrests, with most of these incidences occurring in men who were middle-aged or older. Most sudden deaths occurred during the swim portion of the triathlon. In 44% of cases with an available autopsy report, asymptomatic cardiovascular disease was present. Based on the data, the authors suggest that men over 40 years of age should consider the possible hazards of triathlon participation and the importance of getting screened for cardiovascular disease.
A strength of this study is that it covers more than 30 years of races and over 9 million competitors. Limitations of the study include possible incomplete case identification and underestimation of events. In addition, most cases of prerace medical history were unknown.
Relevant Reading: Sudden death during the triathlon
In-Depth [case series]: In this study, researchers analyzed the incidence of race-related deaths and cardiac arrests taking place during triathlons occurring between 1985 and 2016 in the United States. The authors found 107 sudden deaths, 13 resuscitated cardiac arrests, and 15 trauma deaths, with most incidences happening during the swim portion (n = 90). Eighty-five percent of the fatalities and cardiac arrests were males, and the mean age was 46.7 ± 12.4 years. The incidence of death or cardiac arrest among triathlon participants was 2.40 per 100 000 in men and 0.74 per 100 000 in women. In men, increased age was associated with higher risk. Men >40 years of age had a 3.3 times higher rate of death and cardiac arrest per 100 000 compared to men <40 years of age. In men >60 years of age, the incidence was 18.6 per 100 000. The incidence of cardiovascular events was 3.5-fold higher in men than women. In cases with an available autopsy report, 44% (27 of 61) had cardiovascular abnormalities, including 18 cases of significant atherosclerotic coronary artery disease. Improvements in event organization may help to reduce risks to triathletes. Also, competitors are advised to be aware of the risks of race participation and any possible underlying cardiovascular disease. Competitors should also be sufficiently trained for the event.
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