Football is the most popular sport worldwide and includes the largest population of sports participants, especially in the field of recreational sport. It remains controversial whether football represents a sport discipline with a particular high risk of sudden cardiac death (SCD). The true incidence of SCD among football players is not known due to a lack of football-specific studies. In particular, recreational football players over an age of 35 years with a predominance of coronary artery disease (CAD) who do not exercise regularly are exposed to a higher risk of SCD. Surprisingly, the few European studies that included football as a sport discipline, showed that CAD already plays an important role in the young athlete. Potential pathophysiological mechanisms in football that may lead to a higher risk of SCD include the high release of catecholamines, increased platelet aggregation, dehydration and electrolyte disturbances. Establishment of sport-specific and national registers for SCD should certainly contribute to a better understanding of this highly important topic.