Burtscher M, Pachinger O, Schocke M F H, Ulmer H
Department of Sport Science, University of Innsbruck, Innsbruck, Austria.
Int J Sports Med. 2007 Jul;28(7):621-4. doi: 10.1055/s-2007-964850. Epub 2007 Mar 15.
Mountain hiking is associated with a death rate of about 4 deaths per 100,000 hikers annually. About 50 % of all fatalities during mountain hiking are sudden cardiac deaths (SCDs). But there are only few data available regarding risk factors and triggers associated with SCD during mountain hiking. Thus, a case-control analysis between persons who died suddenly during mountain hiking and randomly selected controls was carried out. Risk factor profiles of 179 males over the age of 34 who suffered SCD during mountain hiking were compared to those of 537 matched controls. Hikers who died suddenly during mountain hiking were much more likely to have had a prior MI (17% vs. 0.9%; p < 0.001), known coronary artery disease (CAD) without prior MI (17 % vs. 4%; p < 0.001), diabetes (6% vs. 1 %; p < 0.001), hypercholesterolemia (54 % vs. 20%; p < 0.001), and were less engaged in regular mountain sports activities (31% vs. 58%; p < 0.001) compared to hikers from the control group. Based on the reported relationship between traditional risk factors and coronary plaque morphology, acute plaque rupture with thrombus formation and subsequent lethal arrhythmias may be assumed to be a dominant mechanism precipitating SCD during hiking. In contrast, in skiers especially non-occlusive plaques may precipitate ischemia leading to an imbalance between oxygen demand and supply and subsequent lethal arrhythmias. As preventive measures recommended to hikers at risk, adaptation to regular mountain sports activities by an adequate training program and pharmacological interventions, e.g. lipid lowering drugs, aspirin, and beta-blockers, should be considered.
山地徒步旅行的年死亡率约为每10万名徒步旅行者中有4人死亡。山地徒步旅行中所有死亡事件约50%为心源性猝死（SCD）。但关于山地徒步旅行期间与SCD相关的危险因素和触发因素的数据很少。因此，对山地徒步旅行期间突然死亡的人员与随机选择的对照组进行了病例对照分析。将179名年龄在34岁以上、在山地徒步旅行期间发生SCD的男性的危险因素概况与537名匹配对照组的情况进行了比较。与对照组的徒步旅行者相比，在山地徒步旅行期间突然死亡的徒步旅行者更有可能曾患心肌梗死（17%对0.9%；p<0.001）、有已知冠状动脉疾病（CAD）但未曾患心肌梗死（17%对4%；p<0.001）、患糖尿病（6%对1%；p<0.001）、患高胆固醇血症（54%对20%；p<0.001），且较少参与常规山地体育活动（31%对58%；p<0.001）。基于传统危险因素与冠状动脉斑块形态之间已报道的关系，急性斑块破裂伴血栓形成以及随后的致命性心律失常可能被认为是徒步旅行期间引发SCD的主要机制。相比之下，在滑雪者中，尤其是非闭塞性斑块可能引发缺血，导致氧供需失衡以及随后的致命性心律失常。作为向有风险的徒步旅行者推荐的预防措施，应考虑通过适当的训练计划和药物干预（如降脂药物、阿司匹林和β受体阻滞剂）来适应常规山地体育活动。
