What is the clinical evidence from this study?

Study design: Cohort. Population: Sudden death (n=1386600). Intervention: Competitive sports activity vs. Non-athletes. Primary outcome: Sudden death (RR 2.5, 95% CI 1.8-3.4, p=<0.0001).

April 23, 2026

Does sports activity enhance the risk of sudden death in adolescents and young adults?

Q: What are the key findings of this study?

Competitive sports activity in adolescents and young adults was associated with an increased risk of sudden death compared to non-athletes (RR 2.5; 95% CI 1.8-3.4; p<0.0001).

Q: What question did this study set out to answer?

This research aims to evaluate the risk of sudden death in adolescents and young adults participating in sports.

Key Result

Competitive sports activity in adolescents and young adults was associated with an increased risk of sudden death compared to non-athletes (RR 2.5; 95% CI 1.8-3.4; p<0.0001).

Key Points

This research aims to evaluate the risk of sudden death in adolescents and young adults participating in sports.
21-year prospective cohort study in the Veneto Region of Italy
Analyzed data from 1,386,600 adolescents and young adults, including 112,790 competitive athletes
Gender-based analysis of sudden death risk and underlying causes in athletic and non-athletic groups.
Incidence rate of sudden death was 1 in 100,000 per year in the overall cohort.
55 cases of sudden death occurred among athletes (2.3 per 100,000 per year) compared to 245 among non-athletes (0.9 per 100,000 per year).
Higher risk of sudden death in athletes linked to cardiovascular diseases, with a relative risk of 2.5 for athletes.

Study Design

Type

Cohort (n=1,386,600)

Structured PICO

Does competitive sports activity increase the risk of sudden death in adolescents and young adults?

Population

Adolescents and young adults age 12 to 35 years in the Veneto Region of Italy. Total population averaged 1,386,600 (692,100 males and 694,500 females).

Intervention

Competitive sports activity (112,790 competitive athletes: 90,690 males and 22,100 females)

Comparator

Non-athletic population

Outcome

Sudden death (SD)hard clinical

Competitive sports activity in adolescents and young adults is associated with a 2.5-fold increased risk of sudden death, primarily by triggering fatal arrhythmias in those with underlying cardiovascular conditions.

Main Result

Effect estimate: RR 2.5 (95% CI 1.8-3.4)

Absolute Event Rate: 2.3% vs 0.9%

p-value: p=<0.0001

Abstract

OBJECTIVES: We sought to assess the risk of sudden death (SD) in both male and female athletes age 12 to 35 years. BACKGROUND: Little is known about the risk of SD in adolescents and young adults engaged in sports. METHODS: We did a 21-year prospective cohort study of all young people of the Veneto Region of Italy. From 1979 to 1999, the total population of adolescents and young adults averaged 1,386,600 (692,100 males and 694,500 females), of which 112,790 (90,690 males and 22,100 females) were competitive athletes. An analysis by gender of risk of SD and underlying pathologic substrates was performed in the athletic and non-athletic populations. RESULTS: There were 300 cases of SD, producing an overall cohort incidence rate of 1 in 100,000 persons per year. Fifty-five SDs occurred among athletes (2.3 in 100,000 per year) and 245 among non-athletes (0.9 in 100,000 per year), with an estimated relative risk (RR) of 2.5 (95% confidence interval CI 1.8 to 3.4; p < 0.0001). The RR of SD among athletes versus non-athletes was 1.95 (CI 1.3 to 2.6; p = 0.0001) for males and 2.00 (CI 0.6 to 4.9; p = 0.15) for females. The higher risk of SD in athletes was strongly related to underlying cardiovascular diseases such as congenital coronary artery anomaly (RR 79, CI 10 to 3,564; p < 0.0001), arrhythmogenic right ventricular cardiomyopathy (RR 5.4, CI 2.5 to 11.2; p < 0.0001), and premature coronary artery disease (RR 2.6, CI 1.2 to 5.1; p = 0.008). CONCLUSIONS: Sports activity in adolescents and young adults was associated with an increased risk of SD, both in males and females. Sports, per se, was not a cause of the enhanced mortality, but it triggered SD in those athletes who were affected by cardiovascular conditions predisposing to life-threatening ventricular arrhythmias during physical exercise.