Abstract 16578: Sudden Death is Less Common in Young Competitive Athletes Than in Non-athletes: But We Systematically Screen Only Athletes

Background: Screening competitive athlete populations for cardiovascular disease is a topic of considerable interest, due to the highly visible sudden deaths (SDs) occurring in young people predominantly with genetic and/or congenital diseases. Media attention to these events may have created the skewed impression that SDs in high school and college students occur almost exclusively in athletes. We address here the important question of whether SDs due to cardiovascular diseases in fact occur largely in competitive athletes, compared to the frequency of such events in young people who are not engaged in sports. Methods: Case records of the Hennepin County (Minneapolis) Medical Examiner were interrogated to identify SDs, age 14-23 years, 2000 to 2014. The number of Hennepin County high school/college students who were competitive athletes (or non-athletes) was estimated from publicly available data sources. Results: Twenty-seven SDs were identified, including 3 individuals who were athletes, either with hypertrophic cardiomyopathy (HCM), a structurally normal heart, or anomalous origin of the left main coronary artery from the right aortic sinus. The other 24 deaths were in young people not involved in organized sports, including: 4 each with HCM or arrhythmogenic right ventricular cardiomyopathy, and 5 with coronary artery disease. Ratio of SDs in non-athletes to athletes was 24 to 3 or 8:1. Incidence of non-athlete SDs over 946,889 person-years was 1:39,454, i.e., 3-fold greater than that for SDs in competitive athletes over 361,841 person-years, i.e., 1:120,614. Conclusion: Cardiovascular SDs are less frequent in competitive athletes than in non-athletes. These data underscore a major (ethical) limitation inherent in confining cardiovascular screening to trained athletes, as is the current practice in the U.S. and elsewhere.