Denmark: A recent study in the European Heart Journal has reported that sports-related sudden cardiac death (SrSCD) is less likely to occur in women than in men. Overall, sports-related SCD incidence was found to be 0.66 per million athlete-years in females versus 5.01 events per million athlete-years in males.
In the review, the researchers noted that in general sudden cardiac death (SCD) is rough twice as common in males versus females. This could be due to the differences in the sports performed and/or exercise intensity.
SCD is a tragic incident that accounts for up to 50% of deaths from cardiovascular disease. Sports-related SCD is a phenomenon that is being related to both competitive and recreational sports activities. SrSCD has been reported to occur 5–33-fold less frequently in women than in men. Despite a rapid increase in female participation in sports, the sex difference persists. Discovering the reasons behind this could help identify targets for improved SrSCD prevention.
Against the above background, Jacob Tfelt-Hansen, Department of Forensic Medicine, Copenhagen University, Copenhagen, Denmark, and colleagues aimed to summarize existing knowledge on epidemiology, characteristics, and causes of SrSCD in females and to elaborates on proposed mechanisms behind the sex difference in a review.
Following are the study's key findings:
Although literature concerning the aetiology of SrSCD in females is limited, proposed mechanisms include sex-specific variations in hormones, blood pressure, autonomic tone, and the presentation of acute coronary syndromes.
These biological differences impact the degree of cardiac hypertrophy, dilation, right ventricular remodelling, myocardial fibrosis, and coronary atherosclerosis, and thereby the occurrence of ventricular arrhythmias in male and female athletes associated with short- and long-term exercise.
Cardiac examinations such as electrocardiograms and echocardiography are useful tools allowing easy differentiation between physiological and pathological cardiac adaptations following exercise in women.
As a significant proportion of SrSCD causes in women are non-structural or unexplained after autopsy, channelopathies may play an important role, encouraging attention to prodromal symptoms and family history.
The researchers conclude that these findings will help in the identification of females at high risk of SrSCD and the development of targeted prevention for female sport participants.
Reference:
Deepthi Rajan, Rodrigue Garcia, Jesper Svane, Jacob Tfelt-Hansen, Risk of sports-related sudden cardiac death in women, European Heart Journal, 2021;, ehab833, https://doi.org/10.1093/eurheartj/ehab833