Heart Care Info - Heart Disease Prevention & Treatment

Letter by Angelini et al Regarding Article,“Incidence of Sudden Cardiac Death in the National Collegiate Athletic Association”

P Angelini, MAA Elayda... - Circulation, 2011 - Am Heart Assoc We read with great interest the report by Harmon et al 1 on sudden cardiac death (SCD) in the National Collegiate Athletic Association (NCAA), a potentially important statement on the incidence of SCD in the young. We would like to offer some comments.

The complex question of how best to estimate the risk of SCD does not seem to have been precisely addressed in this article. The authors used the number of students registered annually with the NCAA over a 5-year period (yielding about 2 million candidates) as the denominator of the risk fraction; the numerator is the number of SCD events that occurred during that period (45), producing a comprehensive “incidence of 2.3/100 000/yr.” We see 3 important potential limitations in this approach: First, most NCAA student-athletes compete for >1 year, so the 2 million years of observation do not represent 2 million different students (but probably half that number). Second, the risk of SCD among athletes, we currently understand, is attributable mainly to (subclinical) cardiovascular defects and maximal physical exertion, not to chance. Third, precertification screening (unreported) for cardiac defects that could cause either SCD or substantial physical limitations during an athlete's initial year(s) of competition will remove that athlete from the study cohort, thereby changing the cohort's risk profile in subsequent years; to quantify the risk, it would probably be better to look only at each athlete's first year of competition.2