Sudden Cardiac Death Risk in Downhill Skiers and Mountain Hikers and Specific Prevention Strategies

Int J Environ Res Public Health. 2021 Feb 8;18(4):1621. doi: 10.3390/ijerph18041621.

Abstract

Sudden cardiac death (SCD) still represents an unanticipated and catastrophic event eliciting from cardiac causes. SCD is the leading cause of non-traumatic deaths during downhill skiing and mountain hiking, related to the fact that these sports are very popular among elderly people. Annually, more than 40 million downhill skiers and mountain hikers/climbers visit mountainous regions of the Alps, including an increasing number of individuals with pre-existing chronic diseases. Data sets from two previously published case-control studies have been used to draw comparisons between the SCD risk of skiers and hikers. Data of interest included demographic variables, cardiovascular risk factors, medical history, physical activity, and additional symptoms and circumstances of sudden death for cases. To establish a potential connection between the SCD risk and sport-specific physical strain, data on cardiorespiratory responses to downhill skiing and mountain hiking, assessed in middle-aged men and women, have been included. It was demonstrated that previous myocardial infarction (MI) (odds ratio; 95% CI: 92.8; 22.8-379.1; p < 0.001) and systemic hypertension (9.0; 4.0-20.6; p < 0.001) were predominant risk factors for SCD in skiers, but previous MI (10.9; 3.8-30.9; p < 0.001) and metabolic disorders like hypercholesterolemia (3.4; 2.2-5.2; p < 0.001) and diabetes (7.4; 1.6-34.3; p < 0.001) in hikers. More weekly high-intensity exercise was protective in skiers (0.17; 0.04-0.74; p = 0.02), while larger amounts of mountain sports activities per year were protective in hikers (0.23; 0.1-0.4; <0.001). In conclusion, previous MI history represents the most important risk factor for SCD in recreational skiers and hikers as well, and adaptation to high-intensity exercise is especially important to prevent SCD in skiers. Moreover, the presented differences in risk factor patterns for SCDs and discussed requirements for physical fitness in skiers and hikers will help physicians to provide specifically targeted advice.

Keywords: altitude; cardiovascular; exercise; fitness; metabolic; mountains.