The Safety of the Long Distance Runner Reply

Long distance runners may be lonely but they are not at high risk for sudden cardiac arrest, according to a study published in the New England Journal of Medicine. The RACER (Race Associated Cardiac Arrest Event Registry) investigators analyzed data from 10.9 million registered participants in marathons and half-marathons that took place in the US during the first decade of this century.

They identified 59 cases of  cardiac arrests; 40 occurred during marathons and 19 occurred during half-marathons. The mean age of the runners with cardiac arrest was 42 years of age. 51 were men and 8 were women.

The rate of cardiac arrest was 1 per 184,000 participants; the rate of death was  1 per 259,000 participants. The authors described this event rate as “relatively low” and compared it with collegiate athletics (1 death per 43,770), triathlons (1 death per 52,630 participants), and previously healthy middle-aged joggers (1 death per 7,620 participants).

Event rates were higher for marathons than for half-marathons and for men than for women. Most events occurred during the last quarter of the race. One possibly disturbing trend– for men but not women– was that the incidence of cardiac arrest increased during the second half of the decade.

The cause of cardiac arrest was determined in 31 cases– hypertrophic cardiomyopathy and possible HCM were the most frequent underlying causes of death. The authors expressed surprise at the absence of any subjects with coronary plaque rupture. By contrast, in a separate correspondence published in NEJM, Alfred Albano and colleagues describe 3 male athletes who developed acute coronary thrombosis after finishing the 2011 Boston Marathon. They noted that all 3 had arrived in Boston after a flight lasting longer than 4 hours.


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