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.

中文翻译：

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竞技运动员心脏骤停/死亡发生率的性别差异：系统评价和荟萃分析

 背景

尽管许多研究表明，女性运动员的心脏骤停或死亡 （SCA/D） 的发生率低于男性，但对具体潜在原因的了解有限。

 目的

本系统评价旨在评估男性和女性竞技运动员之间 SCA/D 发病率的差异，并探讨相关病因。

 方法

对检查男性和女性运动员 SCA/D 发病率的回顾性和前瞻性研究进行了全面检索。根据性别评估发病率和发病率比 （IRR）。

 结果

在分析的 16 项研究中，观察到 1797 例 SCA/D;1578 例发生在男性 （87.81%） 中。年龄从青少年到成人不等。男性的发病率为 1.42/100,000 运动员年 （AY） （95% CI 0.97-2.09），女性为 0.32/100,000 AY （95% CI 0.17-0.59），因此 IRR 为 5.55。当考虑 35 ≤运动员时，男性的发病率为 1.46/100,000 AY（95% CI 0.91-2.34），女性为 0.30/100,000 AY（95% CI 0.14-0.66），IRR 为 5.47。对于 2000 年之后才入组的运动员的最新研究，IRR 为 5.13 （95% CI 3.94-6.67），而其余研究涵盖所有观察年份的 IRR 为 6.02 （95% CI 4.59-7.90）。肥厚型心肌病 （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普遍 （33.04%）。

 结论

女性 SCA/D 的发病率大约比男性低 6 倍，性别差异也是 SCA/D 的主要原因。了解这些差异可能会导致预防运动员 SCD 的针对性策略。

 注册号

（PROSPERO 2023 CRD42023432022）/2023 年 7 月 5 日。