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Cited by 1,559Cardiovascular Effects of ExerciseCardiac electrophysiology and arrhythmiasCardiomyopathy and Myosin Studies

Trends in Sudden Cardiovascular Death in Young Competitive Athletes after Implementation of a Preparticipation Screening Program

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Corrado, Domenico, Basso, Cristina, Pavei, Andrea, Michieli, Pierantonio, Schiavon, Maurizio, Thiene, Gaetano·2006·JAMA
DOI 10.1001/jama.296.13.1593
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Abstract

CONTEXT: A nationwide systematic preparticipation athletic screening was introduced in Italy in 1982. The impact of such a program on prevention of sudden cardiovascular death in the athlete remains to be determined. OBJECTIVE: To analyze trends in incidence rates and cardiovascular causes of sudden death in young competitive athletes in relation to preparticipation screening. DESIGN, SETTING, AND PARTICIPANTS: A population-based study of trends in sudden cardiovascular death in athletic and nonathletic populations aged 12 to 35 years in the Veneto region of Italy between 1979 and 2004. A parallel study examined trends in cardiovascular causes of disqualification from competitive sports in 42,386 athletes undergoing preparticipation screening at the Center for Sports Medicine in Padua (22,312 in the early screening period [1982-1992] and 20,074 in the late screening period [1993-2004]). MAIN OUTCOME MEASURES: Incidence trends of total cardiovascular and cause-specific sudden death in screened athletes and unscreened nonathletes of the same age range over a 26-year period. RESULTS: During the study period, 55 sudden cardiovascular deaths occurred in screened athletes (1.9 deaths/100,000 person-years) and 265 sudden deaths in unscreened nonathletes (0.79 deaths/100,000 person-years). The annual incidence of sudden cardiovascular death in athletes decreased by 89% (from 3.6/100,000 person-years in 1979-1980 to 0.4/100,000 person-years in 2003-2004; P for trend < .001), whereas the incidence of sudden death among the unscreened nonathletic population did not change significantly. The mortality decline started after mandatory screening was implemented and persisted to the late screening period. Compared with the prescreening period (1979-1981), the relative risk of sudden cardiovascular death in athletes was 0.56 in the early screening period (95% CI, 0.29-1.15; P = .04) and 0.21 in the late screening period (95% CI, 0.09-0.48; P = .001). Most of the reduced mortality was due to fewer cases of sudden death from cardiomyopathies (from 1.50/100,000 person-years in the prescreening period to 0.15/100,000 person-years in the late screening period; P for trend = .002). During the study period, 879 athletes (2.0%) were disqualified from competition due to cardiovascular causes at the Center for Sports Medicine: 455 (2.0%) in the early screening period and 424 (2.1%) in the late screening period. The proportion of athletes who were disqualified for cardiomyopathies increased from 20 (4.4%) of 455 in the early screening period to 40 (9.4%) of 424 in the late screening period (P = .005). CONCLUSIONS: The incidence of sudden cardiovascular death in young competitive athletes has substantially declined in the Veneto region of Italy since the introduction of a nationwide systematic screening. Mortality reduction was predominantly due to a lower incidence of sudden death from cardiomyopathies that paralleled the increasing identification of athletes with cardiomyopathies at preparticipation screening.

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  • Arrhythmogenic cardiomyopathy (ACM) is a genetically and phenotypically heterogeneous myocardial disorder characterized by progressive cardiomyocyte loss, immune cell infiltration, and fibro-fatty replacement of the ventricular myocardium.

    “Arrhythmogenic cardiomyopathy (ACM) is a genetically and phenotypically heterogeneous myocardial disorder characterized by progressive cardiomyocyte loss, immune cell infiltration, and fibro-fatty replacement of the ventricular myocardium [1,2,3,4,5].”

    From A Paradigm Shift: Arrhythmogenic Cardiomyopathy Is an Inflammatory Disease (2026) · cites this paper as [1]

    The COMMENT section discusses arrhythmogenic right ventricular cardiomyopathy as a cause of sudden death in athletes and describes its ECG abnormalities. It does not address genetic or phenotypic heterogeneity, progressive cardiomyocyte loss, immune-cell infiltration, or fibro-fatty replacement; searches for those pathological features found no supporting passage. (LLM, conf=0.76)

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Research works printed but not linked: 7

  1. [1]1. Maron BJ, Roberts WC, McAllister MA, et al. Sud- den death in young athletes. Circulation. 1980;62:218- 229.
  2. [19]19. Mitchell JH, Maron BJ, Epstein SE. 16th Be- thesda Conference: cardiovascular abnormalities in the athlete: recommendations regarding eligibility for competition. J Am Coll Cardiol. 1985;6:1186-1232.
  3. [20]20. Comitato Organizzativo Cardiologico per l'Idoneità allo Sport (COCIS). Protocolli cardiologici per il giudizio di idoneità allo sport agonistico. G Ital Cardiol. 1989; 19:250-272.
  4. [27]27. Basso C, Frescura C, Corrado D, et al. Congeni- tal heart disease and sudden death in the young. Hum Pathol. 1995;26:1065-1072.
  5. [28]28. Basso C, Thiene G, Corrado D, et al. Arrhyth- mogenic right ventricular cardiomyopathy: dyspla- sia, dystrophy, or myocarditis? Circulation. 1996;94: 983-991.
  6. [31]31. Basso C, Thiene G, Corrado D, et al. Hyper- trophic cardiomyopathy: pathologic evidence of is- chemic damage in young sudden death victims. Hum Pathol. 2000;31:988-998.
  7. [37]37. Frank S, Braunwald E. Idiopathic hypertrophic sub- aortic stenosis: clinical analysis of 126 patients with emphasis on the natural history. Circulation. 1968;37: 759-788.

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Authors
Corrado, D., Basso, C., Pavei, A., Michieli, P., Schiavon, M., & Thiene, G.
Affiliations
University of Padua (IT)
Corresponding author
Thiene, Gaetano
ORCID
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2006-10-04
Volume
296
Issue
13
Pages
1593
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.296.13.1593
OpenAlex
W1992907868
Cited by
1,559
References
43
Citations by year
2026: 58 · 2025: 66 · 2024: 49 · 2023: 59 · 2022: 55 · 2021: 77 · 2020: 89 · 2019: 59 · 2018: 73 · 2017: 96 · 2016: 101 · 2015: 98 · 2014: 90 · 2013: 104 · 2012: 100
FWCI
46.42
Type
journal article
Language
en
Open access
Licence
other-oa
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
  • Padua Research Archive (University of Padova) (submittedVersion, other-oa)
Funders
Università degli Studi di Padova
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Effects of Exercise
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiomyopathy and Myosin Studies
Keywords
sudden cardiovascular death, pre-participation screening, incidence trends, sudden death prevention, relative risk reduction, mortality decline
MeSH terms
Adolescent, Adult, Electrocardiography, Female, Humans, Italy, Male, Mass Screening, Cardiomyopathies, Sports, Incidence, Death, Sudden, Cardiac

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