Male cardiac mortality and sporting events

Summarized by Robert W. Griffith, MD
January 15, 2001 (Reviewed: December 17, 2002)

Introduction

Several types of events have been characterized as the final straw when added onto an atheromatous-inducing lifestyle: for example, heavy physical work, unusual mental or emotional stress, and alcoholic or eating binges. Events like earthquakes and war are reported to increase the incidence of fatal and non-fatal myocardial infarction (MI). A recent study by Dutch epidemiologists has now shown that sitting in front of a TV set is not without risk, at least for men. The postulated trigger in this case was a European football (soccer) game.

Method

In June 1996 the Dutch football team played against France in the quarterfinals of the European football championship in England; it was a drawn game, even after extra time, and the result was decided on penalty kicks (France won). Based on published ratings, about 9.8 million Dutch people watched the game on TV, representing over 60% of the country's population. Scientists at the University Medical Centre, Utrecht, Netherlands, analyzed mortality data from the central bureau for statistics for June 1995, June 1996 and June 1997, counting all deaths and those from acute MI and stroke. The deaths on the day of the game (June 22) were compared with the mean numbers of daily deaths for the preceding and following 5 days, for all three years. Men and women were analyzed separately.

Results

The numbers of deaths in the population aged 45 years or over are given in the table

	Number of deaths on June 22, 1996	Mean number of daily deaths for the adjacent 10 days	Relative Risk
All causes, men	173	150.1	1.15
All causes, women	146	164.1	0.89
MI or stroke, men	41	27.2	1.51*
MI or stroke, women	38	34.1	1.11

* Statistically significant (95% confidence interval, 1.08 - 2.09)

There was no increase in the rate of cardiovascular mortality on June 22 in 1995 and 1997 compared with the mean for the adjacent 10 days.

Comment

This study showed a significant increase in mortality from MI or stroke in Dutch men on the day of an important football match, compared with the 5 days before and after the game. The high TV viewer rate in the population for this game (60%) suggests that watching may have triggered the excess fatal events. Before a direct cause/effect can be assumed, however, ancillary activities, such as excessive drinking, eating or smoking, have to be considered as possible triggers.

There was no corresponding increased mortality in women at this time. Perhaps fewer women actually watched the game, or they drank or ate less. Alternatively, women may be less vulnerable to the triggers in this case.

The authors of the study discuss the role of triggers in the transition from a non-vulnerable atherosclerotic plaque to one susceptible to disruption; this might be caused by increased sympathetic nervous activity or increased coagulability. In the study, the lowest mortality in men was found on the day after the game; although this difference was not statistically significant, it suggests that the stress induced by watching resulted in an acceleration of mortality, i.e. vulnerable men had their infarct or stroke a day earlier than they would have otherwise.

There are many open questions. The stressful event examined here was relatively easily measured for its associations with mortality; however, there are thousands of other stresses that cannot be so readily evaluated. Can the results here be generalized to other televised sporting events? What would the study results have been if the Netherlands had won?

Nevertheless, these results show that men at risk of a cardiovascular event may indeed increase their risk by an apparent passive activity - in this case, watching football on television. Apart from the usual improvements in lifestyle, protective medication (e.g. aspirin or beta-blockade) may possibly be indicated in such sports fans.

These findings were confirmed in a similar study reported in the British Medical Journal. Admissions for myocardial infarction to English hospitals increased on the day England was eliminated from the 1998 World Cup (soccer) by Argentina in a penalty shoot-out and on the two subsequent days. No effect was seen on admissions for other diagnoses or after other World Cup matches. (Carroll C, et al. Admissions for myocardial infarction and World Cup football: database survey. BMJ 2002; 325:1435-1449).

Source

• Cardiovascular mortality in Dutch men during 1996 European football championship: longitudinal population study. DR Witte, ML Bots, AW Hoes, DE Grobbee, Brit Med J, 2000, vol. 321, pp. 1552--1554

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