Matters of the Heart: Risking it all for the Marathon
As most long distance runners and fans know by now, the sport experienced a great tragedy earlier this month in New York City, when Ryan Shay, one of the USA’s top marathoners, died suddenly in the early miles of the Olympic Trials Marathon.
Posted Wednesday, 28 November, 2007
What many of the same runners and fans may or may not know is that the very next day, a 50-year-old runner, Dr. Matthew Hardy, died after running the New York City Marathon. While both deaths were tragic, Shay’s received much more media attention. That’s not surprising given his youth, his stature as an elite athlete, and that it occurred in a championship race.
In addition to the sincere outpouring of grief for Ryan Shay, the subject of sudden death in the marathon arose once again. Since autopsies on Shay have proved inconclusive to date, many speculated that if a supremely trained and seemingly healthy elite runner such as Ryan Shay could be struck down, they too might be vulnerable. Interestingly, many veteran runners past the age of 50 were far more shaken by Ryan Shay’s death than they were by that of the 50-year-old Hardy, with whom they were much more likely to have something in common, at least in terms of cardiac medical history.
While the reaction to Ryan Shay’s untimely death may seem to be a predictable reaction, it is based more on emotion than logic and probability. His death, and Hardy’s for that matter, will have no real effect on your or my chances of experiencing a similar fate during a marathon. What really matters are our own risk factors and the probability they will manifest themselves during a marathon (or in daily life). That begs the question: how exactly, does one properly evaluate those risk factors to determine if pushing to the limit in a marathon presents a real, quantifiable danger, or whether the odds of catastrophe are so small as to not be significant? And even if we can come up with some mathematical probability, will it affect whether we chose to pursue a sport we love?
The big picture numbers do offer insight when it comes to overall probability. The hundreds of thousands of people who have run marathons during the past several decades provide a tremendous sample size, in which one can determine the likelihood that any one person might suffer a fatal heart event during a marathon. Not surprisingly, that likelihood, or probability, is extremely small.
How small? It is important to first distinguish between sudden cardiac arrest due to arrhythmia or an electrical disturbance of the heart (SCA), and a heart attack due to coronary artery disease (CAD). In seemingly healthy young athletes (such as Shay, although, again, nothing has yet been definitively proved in his case), the former is usually the cause, whereas in older athletes it is frequently the latter cited as the cause of the heart event. Studies have shown that during a marathon, roughly one in 200,000 marathoners will experience a sudden cardiac arrest and one in 50,000 a heart attack due to coronary artery disease. As small as that probability is, it is cold comfort to the runners who are stricken, as well as their families and friends who are left to wonder what went wrong. And when strikes down a supposedly strong, healthy, elite runner such as Ryan Shay, the questions are particularly vexing. And while at first glance one in 50,000 may seem infinitesimal, that is nearly one runner for each year of the New York or Chicago Marathon.
In the early years of the running boom and for many years thereafter, it was widely believed that long distance running enhanced one’s heart health rather than threatened it, that nothing but benefits accrued from long distance running, and those benefits increased with the amount of mileage one logged. Some noted physicians, namely Dr. Thomas Bassler, claimed that marathon level training “immunized” one from coronary heart disease for life.
Now we know how flawed that thinking was. Long ago it was learned that family history and one’s dietary habits play as critical a role (if not greater) in heart health than exercise. The highly publicized death of author Jim Fixx in 1984 highlighted this fact, much to the satisfaction of some percentage of the sedentary population, who cited Fixx’s demise in asserting that exercise was unnecessary at best and detrimental to one’s health at worst. While that is not entirely true, of course, it is not entirely wrong either. A recent study showed that while regular exercise does indeed offer numerous benefits to the heart, some experienced marathoners past the age of 50 had significant calcium deposits in their arteries, thus increasing their likelihood of suffering a heart attack. The recent heart trauma suffered by 1980s marathon star Alberto Salazar has been well documented and highlighted how even those with a history of elite fitness can be vulnerable.
Does that mean that pushing hard in training and in a marathon is detrimental to one's health? Certainly the answer to that question varies greatly among individuals. Should you be more worried about your own marathon running in light of the recent heart attacks and deaths in marathons? That depends greatly on your age, family history, and personal health profile. When it comes to the heart, making generalizations based on the general population is tricky and often misleading. Despite the voluminous research that has been done through the years on the heart, exercise, and stress, there are still many unknowns.
As for sudden cardiac arrest not related to CAD, that can be even trickier to diagnose and treat, especially in young athletes who are not in pain and exhibit no symptoms other than “an enlarged heart.” Since an enlarged heart also is a natural byproduct of exercise, one needs to look a little deeper to determine if an athlete is at risk.
Dr. Paul Thompson, a cardiologist who specializes in heart disease in athletes, says most elite athletes have hearts that are enlarged by exercise; thus, the key is to look not just at the size, but whether the walls of the heart are thicker than normal, forcing the heart to work harder to pump blood. That could be a sign of a potentially dangerous condition called hypertrophic cardiomyopathy, abnormal coronary arteries or an inherited disease that causes heart tissue to pull apart, called arrhythmogenic right ventricular cardiomyopathy. That can cause sudden death in young athletes.
Although Shay was diagnosed with an enlarged heart, he passed extensive performance tests twice a year with passing colors. Who would want to advise an aspiring elite such as Shay to stop training and racing based on the outside possibility that he might be susceptible to SCD? Again, it is a matter of assessing the odds, something no one wants to do when it comes to trying to decide whether to continue doing something they love.
Obviously, in both coronary artery disease and sudden cardiac death due to other heart ailments, the more information one can accrue from testing, the better one will be able to determine if he or she is at risk from pursuing long distance training and racing. That said, testing is not infallible and even in this day and age of advanced technology in medicine, in most cases cannot offer incontrovertible evidence.
Life is full of very small daily risks that we assume in order to do the things we enjoy or are a part of one’s daily routine, such as eating breakfast or pulling the car out of the driveway onto the highway. 99.99 percent of the time, these activities will prove harmless, but probability studies show the chances of your dying in a car accident are far greater than those of running in a marathon. For many, training for and competing in a marathon offers a heightened sense of challenge, excitement, and fun. As has been said before, training and racing can add life to your years, if not years to your life. It’s something that just doesn’t translate into statistics and probability.
More Articles on This Topic
How Enlarged Hearts can Cause Sudden Death in Young Athletes
Sudden Death from Exercise: What Does it Mean For You?
What Might Have Causes Ryan Shay's Death?
Can Marathon Running Damage the Heart?
Running Won’t Save you From Heart Disease
Is Too Much Running Bad for the Heart?
MRI Can Help Identify Heart Risk for Older Runners
ABCs on Cholesterol
Alberto Salazar Knows No Finish Line
Matthew Hardy, 50, Dies in 2007 New York Marathon