Marathon deaths make headlines but are rare, experts say

Amid the cheers of a foot race, a somber murmur occasionally trickles through the crowd when a runner goes down.

Earlier this month, a 27-year-old runner collapsed and died shortly after finishing the Rock 'n' Roll Virginia Beach Half Marathon. It was the third death in the race's 10-year history. Nationwide, similar deaths have generated unsettling headlines.

In March, for instance, a 32-year-old former college baseball player collapsed and died after a half-marathon in Dallas. Last year, three runners died during an event in Detroit, and a few weeks before that, two runners in their 30s died in a race in San Jose, Calif.

A question often reverberates long past a race, particularly among weekend warriors for whom running is more an occasional hobby than a daily routine: Is this safe?

Most experts say the overall rate of deaths among race runners is relatively small. In some cases, there's not much you can do to prevent them. In others, controversy over cost and practicality of screening keeps more from being done.

"It's one of those abnormalities that happens," said Mel Williams, a 72-year-old retired exercise physiologist from Old Dominion University who has run 123 marathons and countless shorter races. "Fortunately, it's pretty rare."

There haven't been many large studies on the topic, but one presented at an American College of Cardiology conference last year reported that the risk of sudden death during a marathon is 0.8 per 100,000 people. The risk of dying from triathlons, which combine running, biking and swimming, was higher, at 1.5 per 100,000.

If it seems like marathon deaths are becoming more frequent, it could be because more amateurs are participating in races during highly visible events, and more people are taking up recreational running.

According to Running USA, the number of finishers in half-marathons doubled from 482,000 to 1.1 million between 2000 and 2009, 5K runners increased by 40 percent and full marathon finishers by 30 percent.

"You get that many people running together, you're going to have a cardiac problem," said Dr. Joel Brenner, a sports medicine specialist based at Children's Hospital of The King's Daughters. "There are some health problems that only show up during extreme physical exertion when there were no signs before. It's not a reason not to run, it's a reason to run smart."

The cause of death of the man who collapsed at the Rock 'n' Roll race has not yet been determined by the medical examiner; that can take 12 to 14 weeks. Police said the runner, Sean McCarthy of Richmond, had no reported medical problems.

There are several categories in which deaths during such races usually fall. While seizures, asthma attacks and heat stroke are sometimes the culprit, the more usual cause is a faulty heart.

For runners older than 40, coronary blockages often lead to a heart attack. Jim Fixx, who is often credited with helping to start a fitness revolution, died of cardiac arrest at 52 after his daily run. An autopsy showed that three of his coronary arteries were clogged. He had a family history of heart disease, and his father died of a heart attack at an even younger age.

In younger runners, sudden cardiac arrest is sometimes caused by a congenital defect, often one that the athlete didn't even know about. For example, "hypertrophic cardiomyopathy," a thickening of the heart muscle wall known as HCM, has been linked to the deaths of Chicago Bears defensive end Gaines Adams, 26, and University of Southern Indiana basketball player Jeron Lewis, 21.

Symptoms include shortness of breath, chest pain, dizziness, fainting and palpitations, but in some cases, cardiac arrest occurs without any prior signs. The defect can run in families, but that's not always the case, which is why it sometimes goes undetected.

An American Heart Association journal study last year examined records of 1,866 athletes who died suddenly while playing 38 different sports over three decades. Half were because of a heart problem, and a third of those because of HCM.

Dr. Alexander Ellis, a cardiologist at CHKD who specializes in congenital heart problems, said that anyone who passes out during exercise should be evaluated for HCM, as should athletes with family members who have died prematurely of cardiac arrest. The condition, which occurs in one in 500 to 600 people, can be treated with medications.

Cardiac arrest also can be caused by other abnormalities in the heart, such as long QT syndrome and Wolff-Parkinson-White syndrome, which cause electrical charges in the heart to misfire.

A third category of heart problems, myocarditis, occurs when heart muscle becomes infected by a virus and produces inflammation. Dr. Paul Marik, a professor of internal medicine at Eastern Virginia Medical School, said the condition often follows a viral infection such as the flu.

These types of cardiac disorders are why student athletes are required to have a "pre-participation physical" before trying out for school sports. But physical exams can go only so far. They don't normally include an electrocardiogram, or EKG, an electrical record of the heart, unless a family history of cardiac arrest prompts such a test.

Italy has raised the standard globally for prevention by requiring annual screening for all athletes 12 to 35 years old. That includes a medical history, a physical exam and an EKG. Marik said there's been debate in the United States over whether such an approach is practical, necessary or cost-effective.

Doctors advise people who run to be cleared by a physician first. Runners should train properly by building up to an event and should be aware of signs of trouble.

"If you pass out or feel like you're close to passing out, you need to stop," Ellis said.

He notes that death while distance racing is not a new phenomenon. "Marathon," after all, comes from the mythical Athenian who ran 26 miles home from the battle of Marathon to declare victory. Already fatigued by battle, the runner collapsed and died, according to legend.

Less obvious at modern-day races are the people who survive after collapsing, said Brenner, co-medical director for the Shamrock Marathon in Virginia Beach. He also has helped direct medical services at marathons in Houston and Chicago. Medical tents staffed with doctors, emergency workers and defibrillators have saved countless lives.

Williams said he hopes the rare deaths during running events do not dissuade people from taking up the sport. Far greater numbers of people are saved from early deaths of heart disease and diabetes through regular exercise.

A 2008 Stanford University study of 500 runners showed the sport can delay death and disability. The study, which followed runners over two decades, found they had fewer disabilities and a longer active life and were half as likely as non-runners of the same age to die early.

"By and large, running conveys so many health benefits," said Williams, who is training for his 35th Marine Corps Marathon in Washington, D.C., next month. "I hate for people to say this is a good reason not to run."

Elizabeth Simpson, (757) 446-2635, elizabeth.simpson@pilotonline.com