SCD: THE MOST COMMON MEDICAL CAUSE OF MORTALITY IN ATHLETES

Eight days after winning the 1984 Belmont Stakes, Claiborne Farm’s Kentucky Derby winner Swale appeared to be as fit as fit can be.  But on his way back to his stall after a morning bath, he dropped over dead from what pathologists determined was heart failure.  A little over thirty-seven years later, on December 6, 2021, another Kentucky Derby winner, Medina Spirit, wobbled and then fell dead during a workout, likely struck down by the same cause as Swale (a necropsy is being conducted).

Sudden cardiac death (SCD) research in human athletes offers valuable insights into understanding SCD in equine athletes.

Global News on June 27, 2021 asked “Why Do Super-Fit Young Athletes Suffer Sudden Cardiac Arrest?” and led in with this narrative:

“The sudden collapse of Danish soccer player Christian Eriksen during his country’s match against Finland at the Euro 2020 championships [in early June 2020] sent shockwaves across the stadium in Copenhagen and the world over.

Towards the end of the first half, the 29-year-old midfielder fell face-first to the turf and lay motionless for several minutes as his teammates huddled around him and the medical staff rushed to the pitch to revive his heart.

Eriksen had suffered a cardiac arrest and had to receive life-saving cardiopulmonary resuscitation (CPR) on the pitch before he was taken to the hospital.

It was a familiar sight soccer fans have witnessed before.”

New England Journal of Medicine statistics from 2017 indicated that approximately 100 to 150 athletes in the United States die from sudden cardiac deaths each year.  The survival rate for athletes who are inflicted is around 44%.

Three physician researchers writing in the April-June 2016 Methodist DeBakey Cardiovascular Journal (“Sudden Cardiac Death in Athletes”) stated that SCD is the most common medical cause of death in athletes.  SCD in athletes younger than 35 years of age “is commonly due to inherited cardiac conditions,” whereas in athletes older than 35, death “is most often due to atherosclerotic coronary artery disease.” 

Besides age, risk factors vary by the sport played, gender, and race.  For example, the authors stated that National Collegiate Athletic Association Division 1 basketball players are estimated to have ten times the risk of SCD than the overall athlete population–1 in 5,200 for basketball vs. 1 in 53,703 for all athletes per year.  Comparative figures for soccer were 1 in 23,689 and for football 1 in 35,951.

NCAA statistics pertaining to risk factors for SCD reveal that male athletes are 3.2 times more at risk than female athletes.  Black athletes are most at risk of SCD, followed by Hispanics, and then caucasians.

In late October, 2021, New York governor Kathy Hochul signed a law establishing rules for monitoring students who are showing signs of sudden cardiac arrest and for administering help.  Such regulation is commendable but is no cure-all, as many athletes have passed screening tests only to later succumb to SCD. 

Jim Fixx’s 1977 bestseller The Complete Book of Running sold over a million copies and helped to fuel the huge popularity of running for health and recreation in the 1970s and 1980s.  Fixx died of heart failure at age 52 while running alone on a Vermont country road.  His father had suffered a heart attack at age 35 and died of a second one at 43.  Several cardiologists pointed out that Jim Fixx’s death shows you can’t entirely overcome your family medical history and DNA, no matter what shape you are in physically.

As is the case with human athletes in a host of sports, some racehorses, sport horses, and show horses will inevitably die of cardiac arrest in training and competition, no matter how much screening is done. And, like high-school athletes who tragically die from exercise-induced heart failure, a number of young horses like Medina Spirit will suffer SCD. That knowledge does not take away the sting and sorrow when it occurs, but scientifically speaking, it is a medical reality.

The allegation by critics that a racehorse dying from cardiac arrest is a cruel outlier in the sports world is patently a falsehood.

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A December 2019 article in the Journal of Atrial Fibrillation, authored by six medical doctors, provides an in-depth and technical probe into the precise causes of SCD deaths of an assortment of world-class athletes like “Pistol Pete” Maravich, Hank Gathers, Reggie Lewis, and “Flo-Jo” Hyman.  Unfortunately, many names could be added to this long and growing list from a variety of sports.

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