Practice Update
Barry J Maron MD
Screening young people for cardiovascular disease has been advocated largely for those engaged in competitive organized sports. Indeed, some clinicians have promoted mandatory screening 12-lead ECGs for all athletes, even on a national level, in an effort to prevent sudden death. This model, initially proposed by Italian investigators, is predicated on the assumption that competitive athletes are at greater risk for cardiovascular sudden death than non-competitive (recreational) athletes or sedentary individuals in the general population. Indeed, it is this belief that competitive athletes are at the highest risk for sudden death that has been used as justification for limiting screening to athlete populations. However, others have raised the concern that confining screening (and its potential opportunities) to athletes is unethical, given that most cardiovascular-based sudden deaths in young people occur in those who are not competitive athletes.
Novel data from Denmark now shed light on this deceptively complex issue.1 In a 3-year period among 5.5 million citizens, 881 sudden cardiac deaths occurred, of which only 44 were sports-related; 75% of those 44 deaths occurred in non-competitive (recreational) athletes. Comparing the non-competitive and competitive athlete populations, the incidence of sports-related sudden death was no different, and notably much lower (by 20-fold) than that encountered in the general population. These data from Denmark add substantially to the ongoing screening debate, arguing against restricting screening to competitive athletes, consistent with the Danish national practice.