• Kevin M Harris, Lawrence L Creswell, Tammy S Haas, Taylor Thomas, Monica Tung, Erin Isaacson, Ross F Garberich, and Barry J Maron.
• From Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota; University of Mississippi Medical Center, Jackson, Mississippi; and Tufts Medical Center, Boston, Massachusetts.
• Ann. Intern. Med. 2017 Oct 17; 167 (8): 529-535.

BackgroundReports of race-related triathlon fatalities have raised questions regarding athlete safety.ObjectiveTo describe death and cardiac arrest among triathlon participants.DesignCase series.SettingUnited States.ParticipantsParticipants in U.S. triathlon races from 1985 to 2016.MeasurementsData on deaths and cardiac arrests were assembled from such sources as the U.S. National Registry of Sudden Death in Athletes (which uses news media, Internet searches, LexisNexis archival databases, and news clipping services) and USA Triathlon (USAT) records. Incidence of death or cardiac arrest in USAT-sanctioned races from 2006 to 2016 was calculated.ResultsA total of 135 sudden deaths, resuscitated cardiac arrests, and trauma-related deaths were compiled; mean (±SE) age of victims was 46.7 ± 12.4 years, and 85% were male. Most sudden deaths and cardiac arrests occurred in the swim segment (n = 90); the others occurred during bicycling (n = 7), running (n = 15), and postrace recovery (n = 8). Fifteen trauma-related deaths occurred during the bike segment. Incidence of death or cardiac arrest among USAT participants (n = 4 776 443) was 1.74 per 100 000 (2.40 in men and 0.74 in women per 100 000; P < 0.001). In men, risk increased substantially with age and was much greater for those aged 60 years and older (18.6 per 100 000 participants). Death or cardiac arrest risk was similar for short, intermediate, and long races (1.61 vs. 1.41 vs. 1.92 per 100 000 participants). At autopsy, 27 of 61 decedents (44%) had clinically relevant cardiovascular abnormalities, most frequently atherosclerotic coronary disease or cardiomyopathy.LimitationsCase identification may be incomplete and may underestimate events, particularly in the early study period. In addition, prerace medical history is unknown in most cases.ConclusionDeaths and cardiac arrests during the triathlon are not rare; most have occurred in middle-aged and older men. Most sudden deaths in triathletes happened during the swim segment, and clinically silent cardiovascular disease was present in an unexpected proportion of decedents.Primary Funding SourceMinneapolis Heart Institute Foundation.

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