Preventing Death

It is obvious that preventing death in sports should be our prime concern. About 30 percent of the deaths of young athletes are due to a heart condition called hypertrophic cardiomyopathy (HCM). In the United States each year, several dozen young athletes die during training or competition from this problem (with another 6,000 non-athlete deaths among the more than 600,000 people with HCM). Prevalence of HCM is significantly higher in dark-skinned individuals, and in men, although African American female athletes have a relatively high incidence. These conditions are considered congenital, acquired before birth during heart development.

About half of the young athletes who die have some other type of unhealthy heart condition, which is also preventable. These include coronary artery abnormalities, abnormally enlarged ventricles, myocarditis (inflammation of the heart), and coronary artery disease. A smaller number, probably less than 2 percent, die from asthma, with prescription and recreational drugs representing about 1 percent of the deaths.

广告：个人专属 VPN，独立 IP，无限流量，多机房切换，还可以屏蔽广告和恶意软件，每月最低仅 5 美元

Accidental death of young athletes not associated with disease occurs in about 20 percent of cases. These are mostly due to blunt force trauma to the chest, which can immediately stop the heart. This occurs when the chest is hit by a ball or other object, or by another person, at a very precise point in the cardiac cycle. The incidence of death by blunt force trauma can be reduced by adhering to specific rules in every sport.

Electrocardiograms (ECGs) are simple and inexpensive tests that can help diagnose many potentially fatal heart problems. Abnormal ECGs are present in 40 percent of trained athletes, including those without detectable disease, are twice as common in men, and are more prevalent in endurance athletes such as runners, swimmers, and cyclists. Most cardiologists would consider these heart abnormalities related to so-called normal physiological changes from training. However, in some highly trained athletes, the abnormal ECGs are identical to non-athlete patients with heart conditions such as HCM and other abnormalities. Whether these changes are due to overtraining, poor lifestyle, or are actually normal may be determined by further evaluations.

The changes observed in the hearts of most athletes are considered to be traininginduced and not unique to some genetic factor. While genetics always plays a role in our development, the hearts of these athletes are primarily associated with non-genetic factors; in addition to training, these include body size and surface area, type of sport, gender, and age.

Most deaths in those with heart problems can be prevented. A discussion of this issue becomes an ethical one as well. Both the International Olympic Committee (IOC) and the European Society of Cardiology (ECS) have advocated that all young competitive athletes be screened routinely and completely (including an extensive history, physical exam, and 12-lead ECG). But the latest guidelines of the American Heart Association do not make this recommendation, saying there is no law in the United States defining legal requirements of sports governing bodies and educational institutions with regard to the screening of competitive athletes. However, in some European countries, local law requires cardiovascular screening, and physicians are considered criminally negligent if they improperly clear an athlete with an undetected cardiovascular abnormality that ultimately leads to death. These strategies have been successful, with about a 90 percent reduction in death from heart disease in competitive athletes.

Many athletes fear cardiovascular screening because if a problem is found they can be banned from competition. Twentythree-year-old college basketball superstar Hank Gathers died during a game in March of 1990; the cause appeared to be myocarditis. Writing in the New England Journal of Medicine, Dr. Barry Morano of the Minneapolis Heart Institute Foundation, and an expert in this field, stated: “It is possible that had Gathers been withdrawn from competitive sports, his heart disease might have resolved within six to twelve months, permitting him to return safely to competition.”

For athletes in their mid-thirties or older, at every level of sport, sudden death is primarily due to atherosclerotic coronary artery disease—also known as clogged arteries. What’s so remarkable here is that this preventable condition can develop through a less-than-healthy lifestyle that begins during youth. These health problems include poor diet, excess stress, and overtraining.

One reason the cause of death changes in athletes over their mid-thirties is time; these individuals have been alive longer and therefore have more time to develop disease. While in young athletes, screening is the measure that can rule out diseases that kill, in older athletes, prevention refers to slowing the aging process that typically causes a buildup of plaque in the blood vessels—this can be remedied with a healthy lifestyle.