There is a low incidence of cardiovascular problems in athletes. However, any untoward event in this population is disconcerting as athletes are considered to be the healthiest segment of our society. Sudden death of popular or famous athletes, especially in team sports that have a large fan following, assume a high public profile and arouse intense interest. It is always a great personal tragedy, but news about these events tends to be disproportionate to their actual impact on public health.

Athletic deaths nationally are difficult to tabulate because of the large number of athletes involved. In addition to the estimated 4.5 million school and college athletes, there are a large number of recreational athletes. Only a very small proportion of participants in organized sports in the US are at risk for death. Estimates range form 1:100,000 to 1:300,000 among high school athletes. For older athletes these range from 1:15,000 among joggers to 1:50,000 among marathon runners.

Moral, ethical and sometimes legal considerations compel and justify organizations and society as a whole to think of ways to screen athletes. However current recommendations for screening have to take into account the low prevalence of cardiovascular abnormalities and that sudden cardiac death is an infrequent event in this population. A complete, honest, careful personal and family history with a physical examination designed to identify high risk individuals is therefore recommended as the best available and practical method.

These recommendations also limit the role of non invasive diagnostic tests, which may be more effective for detecting certain diseases. An important part of the problem is the potential for false positive results in a population with a low prevalence of detectable disease. A false positive result can cause emotional and financial burdens for individuals, teams and institutions with the requirement for additional testing. Borderline tests cannot be completely resolved in some athletes until they stop competing for some time. False negative results occur often as the disease may not be evident or completely expressed with non diagnostic findings at the time of the test. Studies done with systematic screening of athletes with non invasive testing only detected a few potential lethal abnormalities. These tests are therefore not warranted given the overall cost/benefit ratio.

Screening of athletes should not give a false sense of security to doctors, athletes or the general public. The standard recommendations of History & Physical cannot reliably identify many lethal cardiovascular abnormalities. Indeed, the addition of non invasive tests may not identify all the abnormal people as detailed above. It is therefore unrealistic to assume that screening can reliably identify all asymptomatic athletes at high risk.