Risk of sports-related sudden cardiac death in women

Abstract

Sudden cardiac death (SCD) is a tragic incident accountable for up to 50% of deaths from cardiovascular disease. Sports-related SCD (SrSCD) is a phenomenon which has previously been associated with both competitive and recreational sport activities. SrSCD has been found to occur 5–33-fold less frequently in women than in men, and the sex difference persists despite a rapid increase in female participation in sports. Establishing the reasons behind this difference could pinpoint targets for improved prevention of SrSCD. Therefore, this review summarizes existing knowledge on epidemiology, characteristics, and causes of SrSCD in females, and elaborates on proposed mechanisms behind the sex differences. 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. Consequently, 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. Finally, cardiac examinations such as electrocardiograms and echocardiography are useful tools allowing easy differentiation between physiological and pathological cardiac adaptations following exercise in women. However, 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. These findings will aid in the identification of females at high risk of SrSCD and development of targeted prevention for female sport participants.

Sports-related sudden cardiac arrest in young adults

“…12 The reasons for this are not well understood and could include several factors, such as (i) gender differences in the vulnerability to arrhythmic substrates, (ii) the increased prevalence of CAD and myocardial ischaemia among men (CAD was not encountered among women victims in this study), (iii) the more frequent exposure to the triggering effect of high-intensity exercise (men have a cumulative greater exposure to vigorous sports, and the increased SCA risk during an episode of vigorous exertion is much less pronounced among women), (iv) the fact that the relative risk of exercise-induced SCA is reduced in a dose-dependent fashion by habitual exercise less markedly among men compared with women, (v) differences in autonomic modulators, and even (vi) hormonal influences including that of circulating oestrogens. 11,12 Understanding the mechanisms behind the markedly reduced susceptibility of women to SrSCA could have important implications for SCA prevention overall and this area clearly warrants further research. While there was a high proportion of bystander CPR, pre-EMS arrival, AED use by lay bystanders was only performed in a minority of cases.…”

Exercise-Induced Atrial Remodeling in Female Amateur Marathon Runners Assessed by Three-Dimensional and Speckle Tracking Echocardiography

“…In individuals without cardiovascular disease, RVEF is higher in women than men, which may allow sportswomen to better tolerate exercise-induced RV dilatation. Finally, female athletes are less prone to sudden cardiac death (SCD) mainly because of lower sympathetic activation during endurance training and hormonal protection ( Rajan et al, 2021 ).…”

Aukšto Meistriškumo Sportininkų Staigi Mirtis

“…Vis didesnis dėmesys skiriamas priežasčių, lemiančių retesnį SM pasireiškimą AMS moterims nei vyrams, nagrinėjimui. D. Rajan ir bendraautoriai [32] išsamioje literatūros apžvalgoje pateikia su lytimi susijusius fiziologinius bei patofiziologinius skirtumus, galimai lemiančius SM dažnį tarp skirtingų lyčių AMS. Pastebima, kad organizmo atsakas į ilgalaikį FK, sportininkių širdies struktūrų remodeliacija skiriasi nuo vyriškos lyties AMS.…”

“…Pastebima, kad organizmo atsakas į ilgalaikį FK, sportininkių širdies struktūrų remodeliacija skiriasi nuo vyriškos lyties AMS. Lyginant su vyriškos lyties sportininkais, moterims būdinga mažiau išreikšta širdies raumens hipertrofija, kairiojo skilvelio dilatacija, dešiniojo skilvelio remodeliacija, rečiau pasireiškia vainikinių kraujagyslių aterosklerozė, miokardo fibrozė, silpnesnis simpatinės nervų sistemos atsakas į FK [32]. Visi šie veiksniai lemia rečiau išprovokuojamus gyvybei grėsmingus širdies ritmo sutrikimus, galinčius sukelti SM AMS.…”