IJCS | Volume 32, Nº4, July/August 2019

DOI: 10.5935/2359-4802.20190053 Clea Simone S. S Colombo, MD Cardiology and Sports Medicine Consultant Masters of Science in Sports Cardiology at St. George's University of London HCor - Hospital of the Heart, São Paulo, SP. Brazil Sportscardio Cardiology Clinic - Valinhos, SP. Brazil cleacolombo@gmail.com 414 REVIEW ARTICLE International Journal of Cardiovascular Sciences. 2019;32(4):414-417 Mailing Address: Clea Colombo Hospital do Coração - Rua Desembargador Eliseu Guilherme, 147. Postal Code: 04004-030, São Paulo, SP – Brazil. E-mail: cleacolombo@gmail.com Sudden Cardiac Death in Sports: Why Its Prevalence is So Different by Gender? Cléa Simone Sabino de Souza Colombo, 1 Nabil Ghorayeb, 2 T hiago Ghorayeb Garcia, 2 R icardo Contesini Francisco 2 Hospital do Coração, 1 São Paulo, SP - Brazil Instituto Dante Pazzanese de Cardiologia, 2 São Paulo, SP - Brazil Manuscript received on March 20, 2019, revised manuscript on May 06, 2019, accepted on May 22, 2019. Exercises; Sports/physiology; Women; Death, Sudden, Cardiac/prevention and control; Death, Sudden, Cardiac/prevalence; Coronary Artery Disease; Arrhythimias, Cardiac; Cardiomyopathy, Hypertrophic. Keywords Abstract Sports competition can be a trigger to fatal arrhythmias in predisposed individuals, leading to sudden cardiac death. Athletes have 2.8 foldmore risk of sudden cardiac death than non-athletes. However, female athletes seem to have some cardiac protection, dying suddenly much less than men during sports. Although the mechanisms for this protection have not been well established until now, hormonal, genetic and molecular factors may play a role in it. The so-called “fair sex” might harbour the key for sudden cardiac death prevention. Introduction The occurrence of sudden cardiac death (SCD) in sports competition has been described as 10-fold less prevalent in females when compared with male athletes. Literature data show that women are less prone to SCD than men during exercise at any age even among amateur athletes. A large American study analysed US competitive athletes (12-40 years old) who died suddenly over a 27-year period and described that only 11% were females. 1 Likewise, French authors demonstrated similar results performing a nationwide survey in the general population (10-75 years old), where 95% of the sports-related SCD occurred in males. 2 This is an intriguing finding which is not completely understood yet. Previously, it was believed that this would be a consequence of fewer women participating in competitive sports. Moreover, women were considered unable to perform high-intensity exercise and thus, they would not be exposed to a high risk of SCD. 3 However, during the last decades, we have witnessed a sharp increase in female participation in sports, including professional and elite athletes population. Despite this, current data do not present a different scenario in the sex-related differences in SCD occurrence, suggesting that the previous explanation may be too simple. Sudden cardiac death The main cause of SCD in older athletes (> 35 years) is atherosclerotic coronary artery disease whereas in young athletes (< 35 years) are inherited structural or electrical cardiac diseases such as hypertrophic cardiomyopathy (HCM), arrhythmogenic right ventricular cardiomyopathy (ARVC) and ion-channelopathies. 4,5 Structural cardiomyopathies seem to be less prevalent in women than men. Moreover, recent data showed that women who died suddenly usually had a structurally normal heart. 6 The development of these diseases may suffer such influence of estrogens and the female features. There are some studies describing interesting findings and proposing some theories to explain the difference in mortality between men and women. Gender-related differences in the clinical presentation of HCMhas been reported and data suggest that women