Can Athletes Die from Heart Attacks? 

Michelle Routhenstein, MS, RD, CDE

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January 14, 2025

In my practice as a cardiovascular dietitian, I see many athletes who have had a CABG (coronary artery bypass surgery), heart attacks, and other cardiac issues. Many assume they should be at low risk for heart issues due to their active lifestyle and that it must be genetics—but this is a false presumption. 

While athletes are often considered the epitome of health, heart attacks can still occur due to underlying causes. A heart attack doesn’t discriminate based on age, body size, or current personal record. Heart disease is the number one cause of death for adults—including athletes. 

Fortunately, we can take a more proactive approach with athletes by testing their cardiometabolic risk factors (before there’s an issue that sends you to the doctor), and implementing nutrition into the broader picture of lifestyle optimization. 

Athletes and Heart Attacks: Common Causes

Let’s jump into the most frequently asked question about athletes and heart attacks. Why would an athlete experience a heart attack when they’re so fit? Here are some factors:

  • Hypertrophic Cardiomyopathy: A genetic condition causing the heart muscle to thicken, obstruct blood flow, and increase the risk of arrhythmias.
  • Coronary Artery Disease: The buildup of plaque in the coronary arteries, leading to reduced blood flow to the heart and a higher risk of blockages.
  • Arrhythmogenic Right Ventricular Cardiomyopathy: A genetic disorder where heart muscle tissue is replaced by fatty or fibrous tissue, disrupting normal heart rhythms.
  • Myocarditis: Inflammation of the heart is often caused by viral infections, which can weaken the heart and lead to complications.
  • Congenital Heart Defects: Structural issues present at birth that may go undetected until they cause problems during intense activity.
  • Electrical Abnormalities: Disorders like Long QT Syndrome or Wolff-Parkinson-White Syndrome can lead to irregular heart rhythms and sudden cardiac arrest in athletes. 
  • Substance Use: Performance-enhancing drugs, stimulants, or recreational substances can strain the heart and increase the risk of a heart attack.
  • Intense Physical Stress: Extreme exertion may trigger cardiac events, like an exercise-induced heart attack

Symptoms of Sudden Cardiac Arrest in Athletes

Sudden cardiac arrest (SCA) often occurs without warning, but there may be early symptoms in some cases:

  • Sudden collapse without warning signs
  • No detectable pulse 
  • Not breathing or difficulty breathing
  • Chest pain, discomfort, or pressure prior to collapse
  • Dizziness or lightheadedness and feeling generally unsteady
  • Palpitations, or a feeling of a fluttering heart 
  • Extreme unexpected fatigue.
  • Shortness of breath, especially during physical activity
  • Nausea or vomiting 

Being aware of these symptoms and acting quickly, by calling 911 and starting CPR if there’s no pulse, can significantly improve survival outcomes.

Athletes and Sudden Cardiac Death or Heart Disease Risk Factors

How can we reduce the number of athletes with heart disease? First, we need to look at risk factors. 

Genetics

Having a genetic predisposition to heart disease can accelerate it, but it doesn’t cause it. Genetics are responsible for 40 to 60% of coronary artery disease, but they are only half of the equation.  

In other words, just because your parents developed heart disease doesn’t mean that you will automatically have it. But it does mean that you should pay particular attention to your risk factors and reduce them as much as possible. 

A nourishing diet and active lifestyle can offset many of the genetic risk factors by as much as 50 percent. Addressing genetic causes with nutrition helps avoid strain on your heart muscle, especially when leading an active lifestyle. 

Finally, it’s important to be proactive about specific markers of genetic risk and understand what yours may indicate. One such marker is Lipoprotein(a), a type of cholesterol particle that is largely determined by genetics. 

Elevated Lipoprotein(a) can significantly increase the risk of heart disease and isn’t routinely checked in standard lipid panels. If you have a family history of heart disease, ask your healthcare provider to measure your Lipoprotein(a) levels to better understand your risk and take targeted steps to manage it.

Oxidative Stress

https://youtu.be/hawnBgIp8NA

Oxidative stress occurs when there is an imbalance between free radicals—unstable molecules generated during metabolism—and the body’s ability to neutralize them with antioxidants. 

Researchers have found that marathon runners can have a higher calcium artery score than the general population. 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.

Why would this be? It comes down to these athletes carrying more oxidative stress in their bodies. Intense physical activity increases oxygen consumption, leading to higher production of free radicals, particularly during prolonged or high-intensity exercise. Don’t get me wrong—I’m not saying don’t be an athlete. I’m just saying it’s crucial not to overlook your nutrition to help address said oxidative stress. 

According to a 2021 paper in the European Heart Journal, “The current guidelines recommend at least 150 min of moderate exercise or 75 min of vigorous exercise per week. Endurance athletes perform exercise at a level that is 10- to 20-fold greater than these recommendations.” 

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

Excess exercise can also increase parathyroid hormone and decrease vitamin D3 and magnesium levels. These are biomarkers of calcium-phosphate metabolism, and this alteration could affect vascular calcification. Additionally, increased cardiac biomarkers of troponin and BNP are present in these types of intense athletes, which can lead to myocardial fibrosis.

Poor Nutrition

Even athletes can struggle to design a balanced diet that not only fuels their performance and recovery but also provides the vitamins and minerals they need. It’s one thing to focus on calories and macros, and another to look at the types of foods providing these nutrients. 

Nutritional deficiencies aren’t uncommon among athletes. I have seen athletes either overdo their carb-loading for endurance or overdo their protein intake for strength training, in a way that their diet isn’t actually meeting their needs—and may even be promoting stress rather than helping alleviate it in the body.

How to Lower the Risk of Heart Problems in Athletes

The three main pillars for lowering your risk of heart disease or an exercise-induced heart attack include fitness, nutrition, and recovery. 

Evaluate Exercise Intensity

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

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?

Exercise is a very good thing for your heart and body, but it needs to be personalized. For instance, in addition to physical preparation for a competition, there needs to be an emphasis on balanced nutrition for performance and addressing oxidative stress in your body. 

Optimize Nutrition

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 who are under-nourished by not consuming enough nutrients to support recovery are creating an additional type of stress on the body. For instance, I’ve met with athletes who are focused on fueling their workouts with things like glucose drinks and extra protein, but miss the consideration of their heart health. 

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. 

Prioritize Recovery

Rest and recovery are just as important to heart health as exercise. Psychological stress or uncontrolled stress increases the 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. It’s also okay (and important) to take rest days regularly to allow your body to repair. 

Client Success Story

I’ll never forget one of my clients, a 40-year-old athletic gentleman who had a widowmaker heart attack while he went for a run. He participated avidly in CrossFit (high-intensity cardiovascular exercise) daily and had no past medical issues before he had this cardiovascular event.

He also did not have any genetic risk factors and from his physical appearance, he appeared like the label of a fit sportsman: athletically built with no medical issues. So, we examined the underlying factors I discussed above, focusing on his nutrition through my 3-month VIP individual program. 

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.

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 period.

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.” ​​​​​​​​

Athletes and Heart Attacks: Awareness and Prevention Are Key

Are athletes more likely to have heart problems? Not necessarily, but a heart attack can affect anyone, even lean athletes. My client attributed a lot of his success to addressing the underlying root cause with proper science-based nutrition.

If you’re ready to take a proactive approach to reduce your risk for heart disease, then my Heart Optimization Group Program may be for you. If you want a more personalized approach, my 1:1 nutrition counseling may be a better fit.

Click here to schedule your complimentary discovery call with me today.

Sources

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