# Matters of the Heart: Risking it All for the Marathon

As most long-distance runners and fans know, the sport suffered a great tragedy in 2007, when Ryan Shay--one of the USA's top marathoners--died suddenly in the early miles of the Olympic Trials Marathon in New York City.

What many people may not know is the 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. Not surprising given his youth, stature as an elite athlete and that his death occurred in a championship race.

In addition to the sincere outpouring of grief for Ryan Shay, the topic of sudden death surrounding the marathon arose again. Since autopsies on Shay have so far proved inconclusive, many speculated that if a supremely-trained and seemingly healthy elite runner 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.

While the reaction to Ryan Shay's untimely death may seem a predictable response, it's based more on emotion than logic and probability. His death, and Hardy's for that matter, will have no real effect on your chances of experiencing a similar fate during a marathon.

#### Are You at Risk?

What really matters are your own risk factors and the probability they will manifest themselves during a marathon--or in daily life. That begs the question: how do you evaluate those risk factors to determine if 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 choose to pursue a sport we love?

Based on the number of people who have run marathons in the past several decades, and the number of people that suffered a fatal heart event, the probability that any individual person might suffer the same fate during a marathon is extremely small.

How small? First it is important to 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 proven 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 will suffer 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 it strikes down a supposedly strong, healthy, elite runner such as 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.

#### What Effect Does Running Have on Your Heart?

In the early years of the running boom and for many years thereafter, it was widely believed that long-distance running enhanced heart health rather than threatened it, that nothing but benefits accrued from long-distance running and those benefits increased with the amount of mileage logged. Some noted physicians, namely Dr. Thomas Bassler, claimed that marathon level training "immunized" a person from coronary heart disease for life.

Now we know how flawed that thinking was. It has become a known fact that family history and dietary habits play as critical a role--if not a greater role--in heart health than exercise. The highly-publicized death of author Jim Fixx in 1984 highlighted this fact. Some people, however, used Fixx's death as proof that exercise was unnecessary at best and detrimental to one's health at worst. While that is not entirely true, it is not entirely wrong either.

A recent study showed that while regular exercise does indeed benefit 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 highlights how even those with a history of elite fitness can be vulnerable.

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