This mini review examines sudden cardiac death and heart issues in marathon runners. The study looked at people who compete in long-distance races, covering conditions like coronary artery disease and cardiomyopathies. The sample size was not reported, and the setting included various marathon races.
Findings indicate that the risk of sudden cardiac death is higher in men, older runners, and those participating in full-marathon events. Most cardiac arrest events occur during the final phase of the race or shortly after finishing. The causes of these events also depend on age. Coronary artery disease remains the main cause in middle-aged and older runners. In younger athletes, inherited cardiomyopathies, congenital coronary anomalies, and myocarditis are more relevant causes.
Important controversies persist regarding optimal screening intensity, interpretation of subclinical findings, and the dose-response relationship between extreme endurance exercise and cardiovascular risk. The absolute incidence of marathon-associated sudden cardiac death is low. Future efforts should prioritize precision risk stratification, longitudinal evaluation of subclinical cardiovascular abnormalities, integration of wearable monitoring technologies, and standardized race-day emergency preparedness to improve the safety of long-distance running.