Cold Weather and Sudden Death in Marathon

Jackson, Mississippi hosted the 3rd annual Mississippi Blues Marathon this past weekend. The temperatures were bitter cold (17 degrees at the start), but 1,400 or so folks braved the cold to finish the marathon or half marathon events. I twisted my ankle about 10 days ago, or I might have joined my many running friends for the event.

The day was marred by the tragic death of a 40-year-old local man who died in the final mile while he was running the anchor leg for a 5-man relay team. He collapsed suddenly within sight of one of Jackson’s major hospitals. He received immediate medical attention, was taken to the hospital, and was pronounced dead. The events are described in this article from the local Clarion-Ledger newspaper. The coroner did not immediately release a statement about the cause of death.

I’ve received many questions since Saturday about this tragedy and I thought I’d share some of my thoughts here at the blog.

I’ve talked previously here at the blog about causes of death in middle-aged athletes. Here again, the most likely cause of death is cardiac, and specifically a fatal arrhythmia in the setting of coronary artery disease (CAD). A variety of other causes is possible, though, and we will only learn the true cause when an autopsy is completed. Other possibilities would include undetected hypertrophic cardiomyopathy (HCM), some sort of congenital heart disease, or even catastrophic neurologic event such as a stroke.

I’ve been asked about the role that the cold temperature on race day might have played in this runner’s death. It’s an interesting question. Since there are only a handful of deaths annually in the U.S. at marathons, the issue of race-day temperature on the risk of sudden death hasn’t really been studied….and probably can’t be studied. I recall that it was also a cold day in Detroit this fall when 3 runners died of cardiac causes at the Detroit Marathon. Thankfully, deaths at marathons are rare, at only 1 per ~100,000 runners.

If we think about this problem OUTSIDE the setting of athletic pursuits, it turns out that cold temperatures actually ARE associated with an increased frequency of heart attack. We know this from studies that show that heart attacks occur more often in the winter. And it’s generally thought that the cold temperature itself produces some sort of extra stress that might trigger the heart attack. That said, the effect of temperature is relatively small….and heart attacks occur in all temperatures.

We often think about the added stress that HOT or HUMID weather places on athletes in endurance events. But the cold can also add stress. The issues related to cold-weather running are summarized very nicely by Tim Noakes, MD, in his book, Lore of Running, in a section called Cold Hazards. The most important medical concern during cold weather running is hypothermia. And, interestingly, the slower you run (or walk), the more important it becomes to dress warmly.

And lastly, what could have been done to prevent this death? Without more information about his cause of death, I can’t be sure. And I don’t know anything about this runner’s medical history or preparation for the event. Perhaps nothing could have been done. But I’ve said it here at the blog before….if you’re a 40-year-old endurance athlete, it is wise to have a physician, get screened for possible unrecognized heart disease, and treat all warning signs such as chest pain or unusual shortness of breath seriously. Get checked out. And make certain that your goal event makes sense in the context of your medical condition and your athletic preparation for the event.