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Olympic athletes at risk of multiple cardiac disorders

There is an unexpectedly high prevalence of cardiovascular conditions in athletes eligible for the summer and winter Olympic games, some of which were considered as very serious threats to health, according to research presented recently at EuroPRevent 2015.1

The study assessed the cardiovascular health of 2,354 elite athletes (1,435 male, 919 female, mean age 27.6 years) as part of their screening to compete in Olympic games from 2004 onwards. The screening tests took place between 2002 and 2014. The athletes were engaged in 31 different summer and 15 different winter sports disciplines. Their screening included a physical examination, 12-lead and exercise ECG, and echocardiography. Further tests, which included 24-hour ECG monitoring, were given selectively to confirm earlier diagnoses.

The investigators were surprised to find that 171 of the 2,354 athletes screened (7.3%) had some form of cardiovascular abnormality, either structural or electrophysiological (causing a heart rhythm problem). The abnormality in six of the 171 athletes was considered life-threatening and they were disqualified from competition. The abnormalities detected included cardiomyopathies and coronary heart disease. A further 24 athletes were temporarily suspended but were eventually allowed to take part in the Olympic games under close medical surveillance.

Dr Paulo Emilio Adami (Institute of Sport Medicine and Science of the Italian Olympic Committee, Rome)

Dr Paulo Emilio Adami (Institute of Sport Medicine and Science of the Italian Olympic Committee, Rome)

Speaking to BJC Arrhythmia Watch, Dr Paulo Emilio Adami (Institute of Sport Medicine and Science of the Italian Olympic Committee, Rome), who presented the research, said: “Olympic athletes can have cardiovascular disease (CVD). We should not take for granted that, since they are elite athletes, they are free from diseases. This is quite surprising, considering the previous screening they went through, their long athletic career (it takes several years to reach the Olympic level) and the fact that they have reached the Olympic level with, in some cases, life-threatening conditions.”

“Therefore, not only they need to be screened like other athletes, Olympic athletes need a tailored screening protocol. We should always bear in mind the high volume of training they engage and the many years they have been involved in competitive sport,” he added.

“The reason why the protocol we adopted was so effective is because we used a comprehensive approach. It included Physical Examination and History, 12 lead ECG, Exercise test at the bike and Echocardiography for all subjects. Exercise test and echocardiography play fundamental roles in this context. We want to make sure that our athletes’ heart is ‘behaving’ while exercising. Which, by the way, is the activity they are mostly involved during the day,” Dr Adami continued.

“All tests were performed by Sports Cardiologists, who have been specifically trained in recognising the adaptations, induced by prolonged sport participation, from CVD. This role is covered in Italy by Sports Medicine Doctors. These are Specialists who received a 5 year specific training in Sports Medicine after the 6 years of Medical School,” he added.

However, pre-participation of athletes and sports players is controversial, mainly because studies have not yet confirmed beyond doubt that a mass population screening programme would actually detect all the higher risk cases. One study found that around 800 athletes would need to be denied sports activity to prevent one sudden death. Most evidence in favour of screening comes – like this study – from Italy, where a programme to screen all teens and adults in organised sports was introduced in 1982.

In the Veneto region of Italy, for example, the annual incidence of sudden cardiac 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 – whereas the incidence of sudden death among the unscreened non-athletic population did not change significantly. Today, Italians are not eligible for competitive sports until their cardiovascular health has been confirmed.

Dr Adami concluded: “in our research we are not talking about general population or amateur athletes screening. We presented data on Olympic athletes and the protocol we proposed aims at that population. We are well aware of the costs that our screening protocol implies and these might not sustainable if applied to the entire athletic population.”


1. Adami PE, Squeo MR, Quattrini FM, et al. Efficacy of a tailored screening protocol: a six Olympic games screening experience. Presented at EuroPRevent 2015, Lisbon.

Published on: May 28, 2015

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