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Sudden Death During Triathlons

>> Tuesday, May 22, 2018

Ever think that a triathlete seems invincible? They can swim, they can ride, they can run….

Well - think again. It turns out that the risk of sudden death during a triathlon is higher than the risk of sudden death in the general population. 

A recent study is the first to collect data on sudden deaths during triathlons.  (Triathlons consist of a swim, followed by cycling, followed by a run.)  The study reviewed race related deaths during 30 years of triathlons in USA, with data from over 9 million participants.  They identified 135 deaths, for a risk of death of 1.74 per 100,000 participants.  

Perhaps surprisingly, most of the sudden deaths and cardiac arrests (90) occurred during the swim (which starts the race), with 7 during cycling, 15 during the run, and 8 during the post race recovery.  Men age 60 and older were at the highest risk of death at 18.6 per 100,000.  There were also 15 trauma related deaths during cycling. 

Of the 135 deaths, 61 autopsies were performed.  At least 18 of these deaths were due to narrowing of the arteries of the heart.

Why do so many of these sudden deaths occur during the swim, which is at the start of the race?  This may be due to the adrenaline rush at the start of the race increasing the risk of heart arrhythmias, crashes in the water, and/or difficulty in identifying events and initiating rescue, defibrillation and CPR in the water.  This contrasts with data in marathoners (a race of running only), which suggests that sudden deaths in marathons most commonly occur at the end of the race.  Cardiovascular disease accounts for the the majority of marathon-related cardiac arrests.

Bottom Lines:  

1.  Screening for cardiovascular disease when appropriate is important, and triathletes are no exception.  

2.  Organization of races to reduce risk is important: eliminating mass swim starts, and having coordinated safety responses to identify and help people in trouble are key.

PS  - Regular readers - never fear ! I still have several chapter reviews of the Diabetes Canada 2018 Guidelines coming up over the next several weeks.  Stay tuned!

Follow me on twitter! @drsuepedersen © 2018



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