CardioExchange Archive

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In recent years, concerns have been raised about possible adverse cardiovascular effects of intense endurance exercise. Additional concerns have been raised about sports where performance-enhancing drugs are commonly used. However, a new study shows that despite these potential hazards, elite endurance athletes appear to live longer than their contemporaries.

Xavier Jouven, a triathlete and a researcher at the Sudden Death Expertise Center in Paris, France, gathered mortality information from all 786 French participants in the Tour de France from 1947 through 2012 and compared it with mortality in people of the same age in the French general population. The study was presented at the European Society of Cardiology Congress in Amsterdam and published simultaneously in the European Heart Journal.

By 2012, 208 of the French cyclists had died. They had a 41% reduction in mortality compared with their cohorts in the general population (standardized mortality ratio 0.59, CI 0.51-0.68, p<0.0001). Jouven and colleagues estimated that Tour de France athletes on average gain an extra 6 years of life. The results were consistent across age groups except for those under age 30. In this group, there was a nonsignificant increase in mortality (SMR 1.65). “A particularly high frequency of death related to traffic or race accident was observed in that young age group,” explained the researchers.

The mortality benefit for the cyclists was observed across nearly all causes of death, and included significant reductions in cardiovascular, cancer, respiratory, and digestive disease related deaths. The one exception: a small but nonsignificant excess of deaths due to traumatic causes (SMR 1.06). The most common causes of death among the cyclists were neoplasms (32.2%) and cardiovascular diseases (29%), but these occurred less frequently than in the general population.

“Our results do not allow a detailed assessment of the balance between positive effects of high level sports activity and selection of healthy elite athletes, versus any potential deleterious effects of excessive physical exercise or alleged doping,” said Jouven. “Although our results are reassuring to some extent, since no death has been observed since 1990, we have to remain careful since we cannot directly assess the potential harmfulness of doping through our analyses and results.”

Jouven said the results offered reassurance to physicians who may have been reluctant to endorse their patients’ interest in sports. But Sanjay Sharma, the trial discussant and the co-author of an accompanying editorial in the European Heart Journal, disputed the generalizability of the findings. Among other reasons, “the ability to compete in the most arduous endurance sports may in itself indicate a superior genetic composition with lower disease susceptibility.”