Correspondence

Sudden Cardiac Death during Mountain Hiking and Downhill Skiing

N Engl J Med 1993; 329:1738-1739December 2, 1993

Article

To the Editor:

Previous studies have demonstrated an increased incidence of sudden cardiac death associated with exercise1. However, few data are available regarding the risk of sudden cardiac death during participation in mountain sports. We therefore kept a registry of such deaths during mountain hiking and downhill skiing in Austria from 1985 through 1991. All deaths associated with mountain sports were recorded by qualified members of the Ministry of the Interior. The total number of people involved in mountain sports and the frequency of such involvement were determined by an Austrian market-research institute and from records of the numbers of persons transported on ski lifts. Sudden cardiac death was defined as unexpected, nontraumatic death within one hour after the onset of symptoms2.

In Austria approximately 8.5 million people engage in mountain hiking, downhill skiing, or both each year. During the seven-year study period, we recorded a total of 416 sudden cardiac deaths, accounting for about 30 percent of all deaths involving mountain sports. The sudden deaths occurred mainly at an altitude of 1100 to 2100 m (approximately 3600 to 6900 ft). Among men over the age of 34, we calculated one sudden cardiac death per 780,000 hiking hours and one sudden cardiac death per 1,630,000 skiing hours. Our data showed a risk of sudden cardiac death during hiking (Figure 1Figure 1Sudden Cardiac Deaths among Mountain Hikers in Austria.) or skiing among those over the age of 30, with the risk increasing sharply for men over 40. As compared with the overall risk of sudden cardiac death,2 the risk during mountain hiking for men over the age of 34 was increased by a factor of 4.3, and the risk during downhill skiing was increased by a factor of 2.1. The risk for women was much lower than that for men. No increase in risk was found for men who participated regularly in mountain sports. There was one sudden cardiac death per 5 million hiking hours for male members of alpine associations who were over the age of 34.

Coronary artery disease is believed to be the main cause of exercise-related deaths1. In mountain sports, altitude -- along with physical exertion -- may contribute to the risk of sudden cardiac death. The lower risk for downhill skiers as compared with mountain hikers is probably due to different levels of exertion, different degrees of training, or both. Exercise testing and an individual program of endurance training before participation in mountain sports may be advisable for those with symptoms of coronary disease and for physically inactive men over 401. Other preventive measures include adapting to a higher altitude and planning mountain tours according to one's level of fitness.

Martin Burtscher, M.D., Ph.D.
M. Philadelphy, M.D.
R. Likar, M.D.
Health Section of the Austrian Alpine Club, A-6020 Innsbruck, Austria

2 References

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   Friedewald VE Jr, Spence DW. Sudden cardiac death associated with exercise: the risk-benefit issue. Am J Cardiol 1990;66:183-188
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   Cupples LA, Gagnon DR, Kannel WB. Long- and short-term risk of sudden coronary death. Circulation 1992;85:Suppl I:I-11
   

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   Jack M. Goodman, Scott G. Thomas, Jamie Burr. (2011) Evidence-based risk assessment and recommendations for exercise testing and physical activity clearance in apparently healthy individuals ^{1 1} This paper is one of a selection of papers published in this Special Issue, entitled Evidence-based risk assessment and recommendations for physical activity clearance, and has undergone the Journal’s usual peer review process.. Applied Physiology, Nutrition, and Metabolism 36:S1, S14-S32
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   Jeremy S. Windsor, George W. Rodway, Hugh E. Montgomery. (2010) A Review of Electrocardiography in the High Altitude Environment. High Altitude Medicine & Biology 11:1, 51-60
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   Jeremy S. Windsor, Jildou Van Der Kaaij, George W. Rodway, Rahul Mukherjee, Hugh E. Montgomery. (2009) Sudden Cardiac Death in the Mountain Environment. Medicina Sportiva 13:4, 197-202
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