Physical exertion, exercise, and sudden cardiac death in women.
BACKGROUND
Exercise is associated with a lower risk of cardiovascular events but may transiently increase the risk of ventricular arrhythmias. Its short-term and long-term associations with risk of sudden cardiac death among women are unclear.


OBJECTIVE
To compare the risk of sudden cardiac death in women during moderate to vigorous exertion with the risk of sudden cardiac death during lighter or no exertion; and to assess the long-term association between moderate to vigorous exercise and sudden cardiac death.


METHODS
Prospective, nested case-crossover study of 288 cases of sudden cardiac death within the Nurses' Health Study (1980-2004); and a prospective cohort analysis of 69,693 participants without prior cardiovascular disease followed up from 1986-2004.


METHODS
Risk of sudden cardiac death associated with moderate to vigorous exertion.


RESULTS
The absolute risk of sudden cardiac death associated with moderate to vigorous exertion was exceedingly low at 1 per 36.5 million hours of exertion. In case-crossover analyses, the risk of sudden cardiac death was transiently elevated during moderate to vigorous exertion (relative risk [RR], 2.38; 95% confidence interval [CI], 1.23-4.60; P = .01) compared with the risk during lesser or no exertion. Habitual moderate to vigorous exertion modified this transient risk (P = .005 for interaction) and the risk was no longer significantly elevated among those who exercised 2 or more hours per week. In the cohort analyses, an increasing amount of moderate to vigorous exercise was associated with a lower long-term risk of sudden cardiac death in age-adjusted and multivariable models that excluded biological intermediates (P = .006 for trend). This relationship was attenuated when biological intermediates were included (P = .06 for trend); however, the reduction in risk remained significant among women who exercised 4 or more hours per week (adjusted RR, 0.41; 95% CI, 0.20-0.83; P = .01) compared with women who did not exercise.


CONCLUSIONS
These prospective data suggest that sudden cardiac death during exertion is an extremely rare event in women. Regular exercise may significantly minimize this small transient risk and may lower the overall long-term risk of sudden cardiac death.
Cardiovascular Division, Massachusetts General Hospital, Boston, USA.
William
W
Whang
JoAnn E
JE
Manson
Frank B
FB
Hu
Claudia U
CU
Chae
Kathryn M
KM
Rexrode
Walter C
WC
Willett
Meir J
MJ
Stampfer
Christine M
CM
Albert
D000328:Adult; D015331:Cohort Studies; D016757:Death, Sudden, Cardiac / Q000453:epidemiology* / Q000209:etiology; D015444:Exercise / Q000502:physiology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D005082:Physical Exertion / Q000502:physiology*; D012306:Risk