Sex Differences in the Incidence of Sudden Cardiac Arrest/Death in Competitive Athletes: A Systematic Review and Meta-analysis

IF 9.3 1区医学 Q1 SPORT SCIENCES Sports Medicine Pub Date : 2025-01-03 DOI:10.1007/s40279-024-02163-5

Lingxia Li, Solène Le Douairon Lahaye, Shuzhe Ding, Frédéric Schnell

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Abstract

Background

Although many studies have demonstrated a lower incidence of sudden cardiac arrest or death (SCA/D) in female athletes than in male, there is limited understanding of the specific underlying causes.

Objective

This systematic review aimed to assess the disparities in SCA/D incidence between male and female competitive athletes and explore the associated etiologies.

Methods

A comprehensive search was conducted for retrospective and prospective studies examining SCA/D incidence in male and female athletes. Incidence and incidence rate ratios (IRRs) according to sex were evaluated.

Results

Among the 16 studies analyzed, 1797 cases of SCA/D were observed; 1578 occurred in males (87.81%). Ages ranged from adolescent to adult. The incidence was 1.42/100,000 athlete-years (AY) in males (95% CI 0.97–2.09), and 0.32/100,000 AY in females (95% CI 0.17–0.59), resulting in an IRR of 5.55. When considering athletes aged ≤ 35 years, the incidence was 1.46/100,000 AY in males (95% CI 0.91–2.34) and 0.30/100,000 AY in females (95% CI 0.14–0.66), with an IRR of 5.47. The IRR was 5.13 (95% CI 3.94–6.67) for the most recent studies with athletes enrolled only after the year 2000, versus 6.02 (95% CI 4.59–7.90) for the remaining studies covering all observed years. Hypertrophic cardiomyopathy (HCM) was the predominant cause among males (45.12%), while congenital coronary anomalies were more prevalent in females (33.04%).

Conclusion

The incidence of SCA/D in females was approximately 6 times lower than in males, with sex differences also in the leading causes of SCA/D. Understanding these discrepancies could lead to targeted strategies for the prevention of SCD in athletes.

Registration number

(PROSPERO 2023 CRD42023432022)/05.07.2023.

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竞技运动员心脏骤停/死亡发生率的性别差异：系统回顾和荟萃分析

尽管许多研究表明，女性运动员的心脏骤停或死亡（SCA/D）发生率低于男性，但对其具体潜在原因的了解有限。目的本系统综述旨在评估男性和女性竞技运动员SCA/D发病率的差异，并探讨相关病因。方法对男性和女性运动员SCA/D发病率的回顾性和前瞻性研究进行全面检索。按性别评估发病率和发病率比（IRRs）。结果16项研究共发现SCA/D病例1797例；男性1578例（87.81%）。年龄从青少年到成年人不等。男性发病率为1.42/100,000运动年（95% CI 0.97-2.09），女性发病率为0.32/100,000运动年（95% CI 0.17-0.59）， IRR为5.55。当考虑年龄≤35岁的运动员时，男性发病率为1.46/100,000 AY (95% CI 0.91-2.34)，女性发病率为0.30/100,000 AY (95% CI 0.14-0.66)， IRR为5.47。2000年以后入组运动员的最新研究的IRR为5.13 (95% CI 3.94-6.67)，而其余涵盖所有观察年份的研究的IRR为6.02 （95% CI 4.59-7.90）。肥厚性心肌病（HCM）是男性的主要病因（45.12%），而先天性冠状动脉异常在女性中更为普遍（33.04%）。结论女性SCA/D的发生率比男性低约6倍，在SCA/D的主要病因上也存在性别差异。了解这些差异可以为运动员预防SCD制定有针对性的策略。注册号(PROSPERO 2023 CRD42023432022)/05.07.2023。

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来源期刊

Sports Medicine 医学-运动科学

CiteScore

18.40

自引率

5.10%

发文量

165

审稿时长

6-12 weeks

期刊介绍： Sports Medicine focuses on providing definitive and comprehensive review articles that interpret and evaluate current literature, aiming to offer insights into research findings in the sports medicine and exercise field. The journal covers major topics such as sports medicine and sports science, medical syndromes associated with sport and exercise, clinical medicine's role in injury prevention and treatment, exercise for rehabilitation and health, and the application of physiological and biomechanical principles to specific sports. Types of Articles: Review Articles: Definitive and comprehensive reviews that interpret and evaluate current literature to provide rationale for and application of research findings. Leading/Current Opinion Articles: Overviews of contentious or emerging issues in the field. Original Research Articles: High-quality research articles. Enhanced Features: Additional features like slide sets, videos, and animations aimed at increasing the visibility, readership, and educational value of the journal's content. Plain Language Summaries: Summaries accompanying articles to assist readers in understanding important medical advances. Peer Review Process: All manuscripts undergo peer review by international experts to ensure quality and rigor. The journal also welcomes Letters to the Editor, which will be considered for publication.