Prior myocardial infarction is the major risk factor associated with sudden cardiac death during downhill skiing

More than 90% of all sudden cardiac deaths (SCDs) during downhill skiing, t he most popular winter sport world-wide, are attributed to men over the age of 34. However, no data exist on additional risk factors and triggers for SCD related to downhill skiing. Therefore risk factor profiles of 68 males who died from SCD during downhill skiing were compared to those of 204 matc hed controls. Skiers who suffered SCD had much more frequently prior myocar dial infarction (MI) (41% vs. 1.5%; p < 0.001), hypertension (50% vs. 17 %; p < 0.001), known coronary heart disease (CHD) without prior MI (9% vs. 3% ; p = 0.05) and were less engaged in strenuous exercise (4% ars. 15%; p < 0 .05) when compared to controls. Multivariate analyses even enhanced the imp ortance of these risk factors. Downhill skiing is considered to be a seriou s trigger for SCD especially in skiers with prior MI but also for those wit h hypertension, known CHD without prior MI, or insufficient adaptation to s trenuous exercise. Skiing-related increased sympathetic activity might well disturb the autonomic balance with subsequent arrhythmias and/or may incre ase cardiac work and platelet aggregability with possible plaque rupture an d coronary thrombosis. Therefore adaptation to high intensity exercise and therapeutic interventions or abstinence-from skiing in certain cases should be considered for downhill skiers at high risk.