Cardiac arrest during long-distance running races
Open accessAbstract
BACKGROUND: Approximately 2 million people participate in long-distance running races in the United States annually. Reports of race-related cardiac arrests have generated concern about the safety of this activity. METHODS: We assessed the incidence and outcomes of cardiac arrest associated with marathon and half-marathon races in the United States from January 1, 2000, to May 31, 2010. We determined the clinical characteristics of the arrests by interviewing survivors and the next of kin of nonsurvivors, reviewing medical records, and analyzing postmortem data. RESULTS: Of 10.9 million runners, 59 (mean [±SD] age, 42-13 years; 51 men) had cardiac arrest (incidence rate, 0.54 per 100,000 participants; 95% confidence interval [CI], 0.41 to 0.70). Cardiovascular disease accounted for the majority of cardiac arrests. The incidence rate was significantly higher during marathons (1.01 per 100,000; 95% CI, 0.72 to 1.38) than during half-marathons (0.27; 95% CI, 0.17 to 0.43) and among men (0.90 per 100,000; 95% CI, 0.67 to 1.18) than among women (0.16; 95% CI, 0.07 to 0.31). Male marathon runners, the highest-risk group, had an increased incidence of cardiac arrest during the latter half of the study decade (2000-2004, 0.71 per 100,000 [95% CI, 0.31 to 1.40]; 2005-2010, 2.03 per 100,000 [95% CI, 1.33 to 2.98]; P=0.01). Of the 59 cases of cardiac arrest, 42 (71%) were fatal (incidence, 0.39 per 100,000; 95% CI, 0.28 to 0.52). Among the 31 cases with complete clinical data, initiation of bystander-administered cardiopulmonary resuscitation and an underlying diagnosis other than hypertrophic cardiomyopathy were the strongest predictors of survival. CONCLUSIONS: Marathons and half-marathons are associated with a low overall risk of cardiac arrest and sudden death. Cardiac arrest, most commonly attributable to hypertrophic cardiomyopathy or atherosclerotic coronary disease, occurs primarily among male marathon participants; the incidence rate in this group increased during the past decade.
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Autopsy-proved coronary atherosclerosis and structural heart disease, most notably hypertrophic cardiomyopathy, have been reported in marathon runners and triathletes who died while competing.
“Indeed, autopsy-proved coronary atherosclerosis and structural heart disease, most notably, hypertrophic cardiomyopathy, have been reported in marathon runners and triathletes who died while competing [ 65 , 66 ].”
From Physical activity, cardiorespiratory fitness, and cardiovascular health: A clinical practice statement of the American Society for Preventive Cardiology Part II: Physical activity, cardiorespiratory fitness, minimum and goal intensities for exercise training, prescriptive methods, and special patient populations (2022) · cites this paper as [65]
The Causes of Cardiac Arrest and Death section reports hypertrophic cardiomyopathy as the most common cause of death among runners with complete clinical data and notes obstructive coronary artery disease in three nonsurvivors. The autopsy table in the Discussion documents both findings in runners who died. The paper studies marathons and half-marathons, not triathlons, so it does not support the triathlete portion of the sentence. (LLM, conf=0.86)
Experimental — accuracy not yet measuredVigorous-to-high intensity physical activity, particularly when unaccustomed, and some competitive endurance sports are associated with a greater incidence of acute cardiac events.
“Vigorous-to-high intensity PA, particularly when unaccustomed, and some competitive endurance sports (e.g., marathon running and triathlon participation) are associated with a greater incidence of acute cardiac events [ 65 , 66 ].”
From Physical activity, cardiorespiratory fitness, and cardiovascular health: A clinical practice statement of the American Society for Preventive Cardiology Part II: Physical activity, cardiorespiratory fitness, minimum and goal intensities for exercise training, prescriptive methods, and special patient populations (2022) · cites this paper as [65]
The Characteristics and Incidence of Cardiac Arrest section reports a significantly higher cardiac-arrest incidence during marathons than half-marathons, supporting a race-specific association. The paper does not establish that unaccustomed vigorous activity increases acute cardiac events, and it did not study triathlon participants; the Discussion describes the overall risk during long-distance running races as low. (LLM, conf=0.86)
Experimental — accuracy not yet measuredStrenuous physical exercise can trigger the onset of acute myocardial infarction both in sedentary and in highly active people.
“whereas it has been shown that strenuous physical exercise can trigger the onset of acute myocardial infarction both in sedentary33 and in highly active34 people.”
From Effect of exercise training for five years on all cause mortality in older adults—the Generation 100 study: randomised controlled trial (2020) · cites this paper as [34]
The Discussion (page unavailable) links the physiological stress of longer races to cardiac arrest and describes exercise-related acute coronary events in runners. That supports an exertion-related risk in active people, but the paper studies cardiac arrest and myocardial ischemia, not the onset of acute myocardial infarction specifically; it also does not establish the sedentary-population part, which the citing sentence assigns to a different reference. (LLM, conf=0.83)
Experimental — accuracy not yet measuredMarathon running and triathlon participation are associated with acute cardiac events each year.
“First, both activities are associated with acute cardiac events each year [ 65 , 66 ].”
From Physical activity, cardiorespiratory fitness, and cardiovascular health: A clinical practice statement of the American Society for Preventive Cardiology Part II: Physical activity, cardiorespiratory fitness, minimum and goal intensities for exercise training, prescriptive methods, and special patient populations (2022) · cites this paper as [65]
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- Authors
- Kim, J. H., Malhotra, R., Chiampas, G., d'Hemecourt, P., Troyanos, C., Cianca, J., Smith, R. N., Wang, T. J., Roberts, W. O., Thompson, P. D., & Baggish, A. L.
- Affiliations
- Harvard University (US)
- Northwestern University (US)
- Baylor College of Medicine (US)
- University of Minnesota (US)
- Hartford Hospital (US)
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2012-01-12
- Volume
- 366
- Issue
- 2
- Pages
- 130-140
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2097008695
- Cited by
- 597
- References
- 36
- Citations by year
- 2026: 20 · 2025: 31 · 2024: 23 · 2023: 30 · 2022: 25 · 2021: 45 · 2020: 41 · 2019: 53 · 2018: 42 · 2017: 49 · 2016: 42 · 2015: 54 · 2014: 60 · 2013: 40 · 2012: 39
- FWCI
- 39.73
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Pfizer
- AstraZeneca
- GlaxoSmithKline
- Sanofi
- ZOLL Medical Corporation
- Kowa Company
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Effects of Exercise
- Health Sciences › Medicine › Emergency Medicine › Cardiac Arrest and Resuscitation
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- cardiac arrest, long-distance running, marathon runners, half marathon, cardiovascular disease, incidence, mortality, bystander CPR, hypertrophic cardiomyopathy, sudden cardiac death, exercise safety, sex differences, age differences, autopsy findings, exercise-induced arrhythmia, coronary artery disease, atrial fibrillation, myocardial infarction
- MeSH terms
- Adult, Aged, Cardiomyopathy, Hypertrophic, Female, Heart Arrest, Humans, Male, Middle Aged, Risk Factors, Running, Sex Factors, United States, Incidence, Death, Sudden, Cardiac, Young Adult
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