Can Athletes Die from Heart Attacks?

Michelle Routhenstein, MS, RD, CDE


February 15, 2023

Exercise is one of the most powerful tools to help prevent cardiovascular disease, but even physically fit athletes are not immune to heart attacks. Can athletes die from heart attacks?

A heart attack doesn’t discriminate based on how old you are, your body size or your current PR. Heart disease is the number one cause of death for all adults, including athletes. 

Let’s explore the story of my client and discover how we can reduce your risk for a heart attack.

Heart disease is often called the silent killer because many people don’t know they are at risk. 

This was the exact case for my client who is a 40 year old athletic gentleman who had a widowmaker heart attack while he went for a run.

Can Athletes Die from Heart Attacks

Athletes, just like the rest of us, don’t always know whether they are at an increased risk for heart attacks and may be taken by surprise.

My client participated avidly in CrossFit (high-intensity cardiovascular exercise) daily and had no past medical issues before he had this cardiovascular event. Let’s explore some risk factors that may be present in athletes. 

Genetic Risk Factors

We can change everything about our diet, fitness, sleep and stress, but we can’t change our genes. Genetics alone are responsible for 40 to 60% of coronary artery disease, but they are only half of the equation.  

Our genetic risk for heart disease is just a starting point. A nourishing diet and active lifestyle can offset many of the genetic risk factors by as much as 50 percent. This is an encouraging testament to the important role of nutrition and exercise in influencing heart health. 

The following are three common genetic risk factors for heart disease. These conditions don’t prevent an individual from participating in sports. It is possible to live an active lifestyle and play sports with these conditions. 

Congenital heart disease is present at birth. Congenital heart problems affect the structure of the heart and how blood is pumped. 

Inherited heart conditions such as cardiomyopathy affect the walls of the heart. Familial hypercholesterolemia is an inherited genetic disorder of high cholesterol. 

Arrhythmia is an irregular heartbeat. Half of diagnosed arrhythmias are inherited, while other arrhythmias can be caused by a narrowing of arteries and blood vessels affecting your heart beat. 

My client did not have any genetic risk factors and from his physical appearance, he appeared like the label of health –he was athletically built, and with no family or medical issues. So why did he have a heart attack?

Environmental Risk Factors

Managing environmental risk factors is hugely important in minimizing your risk for heart attack. 

Oxidative Stress

It is easy to forget that exercise is a stressor given the multitude of benefits it offers for physical and emotional health. Exercise is a type of hormetic stressor, meaning that the adaptation and recovery from the stress of exercise elicits a positive health benefit. 

However, exercise does create oxidative stress, particularly in high-intensity and long duration activities. The body likes to maintain a balanced state where it can respond to free radicals produced during exercise.

When the amount of free radicals being produced exceeds the body’s ability to clear free radicals, it creates a state of oxidative stress. This stress has a negative impact on the health of our cells and blood vessels. 

Oxidative stress is an underlying cause of plaque formation in the arteries. The plaque formation, in turn, increases the risk of heart attack. One small-scale study of veteran athletes over the age of 40 showed that 25% of the athletes had high coronary calcium scores, despite being at a low- to moderate risk for coronary artery disease. 

Another study of distance runners found a relationship between the distance of the races that the runners participated in and elevated coronary calcium scores. Marathoners and ultramarathoners were more likely to have higher coronary calcium scores than runners participating in shorter distances and national averages.

Overtraining, improper recovery, poor sleep quality and inadequate nutrition post exercise can all play a supporting role in oxidative stress. By working together, we discovered that oxidative stress was a major underlying factor for his heart attack. 


Nutrition plays an active supporting role in promoting good heart health. A balanced diet can help athletes fuel properly before and after workouts. A winning food plan includes a variety of foods that leaves you feeling energized and nutrient sufficient throughout the day. 

Some athletes may restrict calories in an effort to stay lean. Though, athletes who are not getting adequate nutrient packed calories are putting themselves at risk for increased oxidative stress. 

As in the case of my client, a heart attack can affect anyone, even lean athletes. Nutrition interventions can specifically target heart health by including foods that are rich in antioxidants. The antioxidants present in food actively reduce the amount of free radicals. 

Cardiac Arrest in Athletes

Cardiac arrest is the number one cause of sudden death in athletes. Though, cardiac arrest isn’t the same as a heart attack. 

Heart attack occurs when blood flow to a location in the heart is stopped. 

Cardiac arrest is a change in the electrical activity of the heart, causing it to beat irregularly or stop beating completely. These terms are often used interchangeably because cardiac arrest can be a result of a heart attack. 

In simplified terms, heart attacks are mainly a “plumbing” problem due to blockages, while cardiac arrest is an “electrical” problem due to signal changes in the heart. Both can have equally detrimental effects on the heart. 

Cardiac Arrest and Heart Attack in Athletes

Cardiac arrest in athletes shares many of the same origins as a heart attack. Despite the fact that they are two separate events, it is helpful to be aware of the root problems so that we can develop a preventative plan of action. 

This table outlines some of the most common causes of cardiac arrest and heart attacks in athletes. 

Hypertrophic CardiomyopathyThickening wall of heart muscle, most common cause of sudden cardiac death in young athletesUsually genetic 
Left Ventricular HypertrophyEnlargement of the left ventricle seen in endurance athletesExercise adaptation
ArrhythmiaIrregular heartbeatHeart disease, previous heart attack, diabetes, cardiomyopathy
Plaque FormationNarrowing of blood vessels from plaque accumulationGenetics, unbalanced diet, high blood pressure, high cholesterol
Aortic AneurysmBulge from a weakening in the largest artery, the aortic arteryDiseases that affect circulatory system, high blood pressure, being overweight
FibrosisScarring that occurs in heart muscle and valvesCoronary heart disease, high blood pressure, heart valve disease (aortic stenosis)
Atrial FibrillationIrregular, fast heartbeatElectrical misfiring in the heart from coronary artery disease caused by a variety of factors from inborn heart conditions to coronary artery disease and lifestyle factors
Elevated Coronary Calcium ScoreHeart scan to assess the amount of calcium build up in the coronary artery. The higher the score, the increased risk for heart diseaseElevated cholesterol, chronic disease, inflammatory conditions, glucose-related disorders, kidney disease

After his heart attack, my client joined my 3 month VIP nutrition individual program. We worked closely together to optimize his nutrition. Our goal was to improve his cardiovascular function (his ejection fraction was 30% post heart attack, indicating heart failure), and reduce his risk of a future cardiovascular event. He also participated in an in-person cardiac rehabilitation alongside the nutrition program.

How to Lower Your Risk for Heart Attack in Athletes

The three main pillars for lowering your risk of heart attack include fitness, nutrition and recovery. 


Exercise can be cardioprotective, but once an athlete crosses the threshold into overtraining and insufficient nutrition, it can become problematic. Indications of overtraining include general fatigue, poor sleep quality, inability to recover like usual to workouts. Overtraining can also cause emotional fatigue for many athletes. 

Examine your current workout routine. Does it include a variety of exercise types and intensities? Are you including active recovery or rest days, especially following strenuous activity? Are you properly fueling before, and after exercise?


Properly fueling before and after each workout can influence the body’s ability to combat oxidative stress. Nutrition plays a large supporting role in reducing the potentially damaging effects of free radicals. 

In particular, athletes that are under-nourished by not consuming enough calories or enough nutrients to support recovery are creating an additional type of stress on the body. 

A heart-healthy diet isn’t about cutting foods, it is about adding nourishing foods to fuel the body. Creating a balance of micronutrients and macronutrients to optimize heart health is at the core of the Heart Optimization Program

Emphasis should be placed on including foods that have a high nutritional value that quench free radicals and aid in recovery. These types of foods include whole grains, polyphenol rich fruits, nitric oxide rich vegetables, lean protein, beans, nuts, seeds and limited amounts of heart-healthy oils such as olive oil. 


Rest and recovery are just as important to heart health as exercise. Psychological stress or uncontrolled stress increases production of free radicals and accelerates aging. One way to manage stress is through mindfulness and meditation. It has been shown as an effective means to help lower the damaging effects of oxidative stress.

With a focus on lifestyle changes and recovery, in 3 months, my client had increased his ejection fraction to 47% and his blood tests were excellent. 

In fact, his cardiac rehab center asked him to be part of the testimonial advertisement. They had never seen such a significant positive change in strength and recovery in such a short time span. 

I recently received an email from him (6 months after he completed the program), where he stated “Hi Michelle, just an update. All doing great. My EF is now at 61% and all the readings are good I’m also off of my beta blockers and statin. My bad cholesterol went from 138 to 28 it’s been amazing how my food intake has transformed it all. Thank you” ​​​​​​​​

​​​​​​​​I am honored to have been able to help my client optimize his heart health! ​​​​​​​​Please take a proactive heart healthy approach today! Don’t wait until something unexpectedly happens!​​​​​​​​


Protecting Your Heart Health

As an athlete, even if you are lean with no previous medical diagnosis like my client, being proactive with your heart health might just save your life. 

My client attributed a lot of his success to being nutrient sufficient and addressing the underlying root cause with proper science-based nutrition.

If you are ready to take a proactive approach to reduce your risk for heart disease, then my Heart Optimization Group Program is right for you. 

If you want a more personalized 1 on 1 approach to science based nutrition for optimal heart health, my 1:1 nutrition counseling may be a better fit for you. To learn more about my 1 on 1 services, schedule your complimentary discovery call with me today.


1. McPherson R, Tybaerg-Hansen A. Genetics of Coronary Artery Disease. Circulation Research.2016;118(4):564-578. doi:10.1161/circreasha.115.306566

2. National Library of Medicine. Medline Plus. Congenital Heart Disease. Updated August 20,2022. 

3. Khera A, Emdin C, Drake I, Natarjan P, Bick A, Cook N, Chasman D, Baber U, Mehran R, Rader D, Fuster V, Boerwinkle E, et al. Genetic Risk, Adherence to a Healthy Lifestyle, and Coronary Artery Disease. New England Journal of Medicine. 2016;375:2349-2358.doi:10.1056/NEJMoa1605086. 

4. Gray B, Behr E. New Insights into the Genetic Basis of Inherited Arrhythmia Syndromes. Circulation.2016;9(6):569-577.doi:10.1161/circgenetics.116.001571.

5. Fisher-Wellman, K., Bloomer, R.J. Acute exercise and oxidative stress: a 30 year history. Dynamic Medicine.2009; 8(1). doi:10.1186/1476-5918-8-1.

6. Dores H, de Araújo Gonçalves P, Monge J, et al. Subclinical coronary artery disease in veteran athletes: is a new preparticipation methodology required? British Journal of Sports Medicine 2020;54:349-353. 

7. Jafar O, Friedman J, Bogdanowicz I, Muneer A, Thompson P, Ling J, Messina A, Yen M, Wakefield D, Varanasi P, Haleem K. Assessment of Coronary Atherosclerosis Using Calcium Scores in Short- and Long-Distance Runners. Mayo Clinic Proceedings: Innovations, Quality & Outcomes. 2019;3(2):116-121. Doi: 10.1016/j.mayocpiqo.2019.03.009.

8. Hajouli S, Ludhwani D. Heart Failure And Ejection Fraction. [Updated 2022 Aug 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; Jan 2022. Available from:

9. Saha SK, Lee SB, Won J, Choi HY, Kim K, Yang G-M, Dayem AA, Cho S-g. Correlation between Oxidative Stress, Nutrition, and Cancer Initiation. International Journal of Molecular Sciences. 2017;18(7):1544. doi:10.3390/ijms18071544.

10. Aschbacher K, O’Donovan A, Wolkowitz O, Dhabhar F, Su Y, Epel E.

Good stress, bad stress and oxidative stress: Insights from anticipatory cortisol reactivity.

Psychoneuroendocrinology.2013;38(9):1698-1708. doi:10.1016/j.psyneuen.2013.02.004.

11. Dal Lin C, Brugnolo L, Marinova M, Plebani M, Iliceto S, Tona F, Vitiello G. Toward a Unified View of Cognitive and Biochemical Activity: Meditation and Linguistic Self-Reconstructing May Lead to Inflammation and Oxidative Stress Improvement. Entropy. 2020;22(8):818. doi:10.3390/e22080818.

12. American Heart Association. Ejection Fraction Heart Failure Measurement. Reviewed May 16, 2017. Accessed January 31, 2023.

© Copyright 2023 Entirely Nourished, LLC. All Rights Reserved. Terms. Privacy Policy. Disclaimer.

Brand and Web Design by