The heart of the matter: years-saved from cardiovascular and cancer deaths in an elite athlete cohort with over a century of follow-up

Abstract

To quantify the years of life saved from cardiovascular (CVD), cancer and overall deaths among elite athletes according to their main type of physiological effort performed in the Olympic Games. All French athletes participating in the Games from 1912 to 2012, with vital status validated and cause of death (if concerned) identified by the national registries were included (n = 2814, 455 died) and classified according to 6 groups of effort: POWER (continuous effort < 45 s); INTERMEDIATE (45 s ≤ continuous effort < 600 s); ENDURANCE (continuous effort ≥ 600 s); POLYVALENT (participating in different events entering different classifications), INTERMITTENT (intermittent effort, i.e. team sports); PRECISION (targeting events). The theoretical years-lost method was adapted to calculate gains in longevity (years-saved) according to specific-risks under the competing risks model and was implemented in R software. Considering overall-deaths, all groups significantly saved, on average, 6.5 years of life (95% CI 5.8–7.2) compared to the general population. This longevity advantage is mainly driven by a lower risk of cancer which, isolated, contributed to significantly save 2.3 years of life (95% CI 1.2–1.9) on average in each group. The risk of CVD-related mortality in the ENDURANCE and PRECISION groups is not significantly different from the general population. The other groups significantly saved, on average, 1.6 years of life (95% CI 1.2–1.9) from CVD death. The longevity benefits in elite athletes are associated with the type of effort performed during their career, mainly due to differences on the CVD-risk of death.

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References

  1. 1.

    Garatachea N, Santos-Lozano A, Sanchis-Gomar F, Fiuza-Luces C, Pareja-Galeano H, Emanuele E, et al. Elite athletes live longer than the general population: a meta-analysis. Mayo Clin Proc. 2014;89:1195–200.

    Article  PubMed  Google Scholar 

  2. 2.

    Antero-Jacquemin J, Rey G, Marc A, Dor F, Haïda A, Marck A, et al. Mortality in female and male French olympians: a 1948–2013 cohort study. Am J Sports Med. 2015;43:1505–12.

    Article  PubMed  Google Scholar 

  3. 3.

    Antero-Jacquemin J, Desgorces FD, Dor F, Sedeaud A, Haïda A, LeVan P, et al. Row for your life: a century of mortality follow-up of French olympic rowers. PLoS ONE. 2014;9:e113362.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  4. 4.

    Marijon E, Tafflet M, Antero-Jacquemin J, Helou NE, Berthelot G, Celermajer DS, et al. Mortality of French participants in the Tour de France (1947–2012). Eur Heart J. 2013;34:3145–50.

    Article  PubMed  Google Scholar 

  5. 5.

    Clarke PM, Walter SJ, Hayen A, Mallon WJ, Heijmans J, Studdert DM. Survival of the fittest: retrospective cohort study of the longevity of Olympic medallists in the modern era. BMJ. 2012;345:e8308.

    Article  PubMed  Google Scholar 

  6. 6.

    Kujala UM, Tikkanen HO, Sarna S, Pukkala E, Kaprio J, Koskenvuo M. Disease-specific mortality among elite athletes. JAMA, J Am Med Assoc. 2001;285:44–5.

    Article  CAS  Google Scholar 

  7. 7.

    Bohm P, Schneider G, Linneweber L, Rentzsch A, Krämer N, Abdul-Khaliq H, et al. Right and left ventricular function and mass in male elite master athletes clinical perspective. Circulation. 2016;133:1927–35.

    Article  PubMed  Google Scholar 

  8. 8.

    Heidbuchel H, Claessen G, La Gerche A. Letter by Heidbuchel et al Regarding Article, “Right and left ventricular function and mass in male elite master athletes: a controlled contrast-enhanced cardiovascular magnetic resonance study”. Circulation. 2016;134:e360–1.

    Article  PubMed  Google Scholar 

  9. 9.

    O’Keefe JH, Lavie CJ. Run for your life… at a comfortable speed and not too far. Heart. 2013;99:516–9.

    Article  PubMed  Google Scholar 

  10. 10.

    Eijsvogels TMH, George KP, Thompson PD. Cardiovascular benefits and risks across the physical activity continuum. Curr Opin Cardiol. 2016;31:566–71.

    Article  PubMed  Google Scholar 

  11. 11.

    Lavie CJ, O’Keefe JH, Sallis RE. Exercise and the heart—the harm of too little and too much. Curr Sports Med Rep. 2015;14:104–9.

    Article  PubMed  Google Scholar 

  12. 12.

    Bhatti SK, O’Keefe JH, Lavie CJ. Of mice and men: atrial fibrillation in veteran endurance runners. J Am Coll Cardiol. 2014;63:89.

    Article  PubMed  Google Scholar 

  13. 13.

    Pelliccia A, Kinoshita N, Pisicchio C, Quattrini F, Dipaolo FM, Ciardo R, et al. Long-term clinical consequences of intense, uninterrupted endurance training in olympic athletes. J Am Coll Cardiol. 2010;55:1619–25.

    Article  PubMed  Google Scholar 

  14. 14.

    Baldesberger S, Bauersfeld U, Candinas R, Seifert B, Zuber M, Ritter M, et al. Sinus node disease and arrhythmias in the long-term follow-up of former professional cyclists. Eur Heart J. 2008;29:71–8.

    Article  PubMed  Google Scholar 

  15. 15.

    Andersen PK. Decomposition of number of life years lost according to causes of death. Stat Med. 2013;32:5278–85.

    Article  PubMed  CAS  Google Scholar 

  16. 16.

    Andersen PK, Canudas-Romo V, Keiding N. Cause-specific measures of life years lost. Demogr Res. 2013;29:1127–52.

    Article  Google Scholar 

  17. 17.

    Kessing LV, Vradi E, McIntyre RS, Andersen PK. Causes of decreased life expectancy over the life span in bipolar disorder. J Affect Disord. 2015;180:142–7.

    Article  PubMed  Google Scholar 

  18. 18.

    Zwiers R, Zantvoord FWA, Engelaer FM, van Bodegom D, van der Ouderaa FJG, Westendorp RGJ. Mortality in former Olympic athletes: retrospective cohort analysis. BMJ. 2012;345:e7456.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  19. 19.

    Berthelot G, Sedeaud A, Marck A, Antero-Jacquemin J, Schipman J, Saulière G, et al. Has athletic performance reached its peak? Sports Med Auckl NZ. 2015;45:1263–71.

    Article  Google Scholar 

  20. 20.

    Marck A, Antero J, Berthelot G, Saulière G, Jancovici J-M, Masson-Delmotte V, et al. Are we reaching the limits of homo sapiens? Front Physiol. 2017;8:812.

    Article  PubMed  PubMed Central  Google Scholar 

  21. 21.

    Rittweger J, di Prampero PE, Maffulli N, Narici MV. Sprint and endurance power and ageing: an analysis of master athletic world records. Proc R Soc Lond B Biol Sci. 2009;276:683–9.

    Article  Google Scholar 

  22. 22.

    Rey G. Death certificate data in France: production process and main types of analyses. Rev Med Interne. 2016;37:685–93.

    Article  PubMed  CAS  Google Scholar 

  23. 23.

    Mitchell JH, Haskell W, Snell P, Van Camp SP. Task force 8: classification of sports. J Am Coll Cardiol. 2005;45:1364–7.

    Article  PubMed  Google Scholar 

  24. 24.

    McArdle WD, Katch FI, Katch VL. Exercise physiology: nutrition, energy, and human performance. 8th ed. Philadelphia: LWW; 2014.

    Google Scholar 

  25. 25.

    Allignol A, Schumacher M, Wanner C, Drechsler C, Beyersmann J. Understanding competing risks: a simulation point of view. BMC Med Res Methodol. 2011;11:86.

    Article  PubMed  PubMed Central  Google Scholar 

  26. 26.

    Andersen PK, Keiding N. Interpretability and importance of functionals in competing risks and multistate models. Stat Med. 2012;31:1074–88.

    Article  PubMed  Google Scholar 

  27. 27.

    Dignam JJ, Zhang Q, Kocherginsky MN. The use and interpretion of competing risks regression models. Clin Cancer Res. 2012;18:2301–8.

    Article  PubMed  PubMed Central  Google Scholar 

  28. 28.

    Fox EL, Bowers RW, Foss ML. The physiological basis of physical education and athletics. 4 sub ed. Dubuque, IA: William C Brown Pub; 1989.

    Google Scholar 

  29. 29.

    Alpérovitch A, Bertrand M, Jougla E, Vidal J-S, Ducimetière P, Helmer C, et al. Do we really know the cause of death of the very old? comparison between official mortality statistics and cohort study classification. Eur J Epidemiol. 2009;24:669–75.

    Article  PubMed  Google Scholar 

  30. 30.

    Andersen PK, Klein JP, Rosthøj S. Generalised linear models for correlated pseudo-observations, with applications to multi-state models. Biometrika. 2003;90:15–27.

    Article  Google Scholar 

  31. 31.

    Strasser B, Burtscher M. Survival of the fittest: VO2max, a key predictor of longevity? Front Biosci Landmark Ed. 2018;23:1505–16.

    Article  PubMed  Google Scholar 

  32. 32.

    Sayer AA, Kirkwood TBL. Grip strength and mortality: a biomarker of ageing? The Lancet [Internet]. 2015 [Cited 2015 Jun 21]. http://linkinghub.elsevier.com/retrieve/pii/S0140673614623497.

  33. 33.

    Stanaway FF, Gnjidic D, Blyth FM, Le Couteur DG, Naganathan V, Waite L, et al. How fast does the Grim Reaper walk? Receiver operating characteristics curve analysis in healthy men aged 70 and over. BMJ. 2011;343:d7679.

    Article  PubMed  PubMed Central  Google Scholar 

  34. 34.

    Kujala UM, Sarna S, Kaprio J, Tikkanen HO, Koskenvuo M. Natural selection to sports, later physical activity habits, and coronary heart disease. Br J Sports Med. 2000;34:445–9.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  35. 35.

    Zaidi A, Sharma S. Reduced mortality in former Tour de France participants: the benefits from intensive exercise or a select genetic tour de force? Eur Heart J. 2013;34:3106–8.

    Article  PubMed  Google Scholar 

  36. 36.

    Schmidt JF, Andersen TR, Andersen LJ, Randers MB, Hornstrup T, Hansen PR, et al. Cardiovascular function is better in veteran football players than age-matched untrained elderly healthy men. Scand J Med Sci Sports. 2015;25:61–9.

    Article  PubMed  CAS  Google Scholar 

  37. 37.

    Predel H-G. Marathon run: cardiovascular adaptation and cardiovascular risk. Eur Heart J. 2014;35:3091–8.

    Article  PubMed  CAS  Google Scholar 

  38. 38.

    Semsarian C, Sweeting J, Ackerman MJ. Sudden cardiac death in athletes. BMJ. 2015;350:h1218.

    Article  PubMed  Google Scholar 

  39. 39.

    Prior DL, Gerche AL. The athlete’s. Heart. 2012;98:947–55.

    Article  PubMed  Google Scholar 

  40. 40.

    Harmon KG, Asif IM, Maleszewski JJ, Owens DS, Prutkin JM, Salerno JC, et al. Incidence, cause, and comparative frequency of sudden cardiac death in national collegiate athletic association athletes: a decade in review. Circulation. 2015;132:10–9.

    Article  PubMed  PubMed Central  Google Scholar 

  41. 41.

    Weinstock J, Estes NAM. The heart of an athlete. Circulation. 2013;127:1757–9.

    Article  PubMed  Google Scholar 

  42. 42.

    Arbab-Zadeh A, Perhonen M, Howden E, Peshock RM, Zhang R, Adams-Huet B, et al. Cardiac remodeling in response to 1 year of intensive endurance training. Circulation. 2014;130:2152–61.

    Article  PubMed  PubMed Central  Google Scholar 

  43. 43.

    Merghani A, Malhotra A, Sharma S. The U-shaped relationship between exercise and cardiac morbidity. Trends Cardiovasc Med. 2015;26:232–40.

    Article  PubMed  Google Scholar 

  44. 44.

    Benito B, Gay-Jordi G, Serrano-Mollar A, Guasch E, Shi Y, Tardif J-C, et al. Cardiac arrhythmogenic remodeling in a rat model of long-term intensive exercise training. Circulation. 2011;123:13–22.

    Article  PubMed  Google Scholar 

  45. 45.

    Guasch E, Mont L. Exercise and the heart: unmasking Mr Hyde. Heart. 2014;1:999–1000.

    Article  Google Scholar 

  46. 46.

    Lee D, Brellenthin AG, Thompson PD, Sui X, Lee I-M, Lavie CJ. Running as a key lifestyle medicine for longevity. Prog Cardiovasc Dis [Internet]. [Cited 2017 Apr 18]. http://www.sciencedirect.com/science/article/pii/S0033062017300488.

  47. 47.

    Lee D, Lavie CJ, Vedanthan R. Optimal dose of running for longevity: is more better or worse? J Am Coll Cardiol. 2015;65:420–2.

    Article  PubMed  Google Scholar 

  48. 48.

    Schnohr P, O’Keefe JH, Marott JL, Lange P, Jensen GB. Dose of jogging and long-term mortality: the Copenhagen City Heart Study. J Am Coll Cardiol. 2015;65:411–9.

    Article  PubMed  Google Scholar 

  49. 49.

    Marc A, Sedeaud A, Guillaume M, Rizk M, Schipman J, Antero-Jacquemin J, et al. Marathon progress: demography, morphology and environment. J Sports Sci. 2014;32:524–32.

    Article  PubMed  Google Scholar 

  50. 50.

    Kim JH, Malhotra R, Chiampas G, d’Hemecourt P, Troyanos C, Cianca J, et al. Cardiac arrest during long-distance running races. N Engl J Med. 2012;366:130–40.

    Article  PubMed  CAS  Google Scholar 

  51. 51.

    Sanchis-Gomar F, Santos-Lozano A, Garatachea N, Pareja-Galeano H, Fiuza-Luces C, Joyner MJ, et al. My patient wants to perform strenuous endurance exercise. What’s the right advice? Int J Cardiol. 2015;197:248–53.

    Article  PubMed  Google Scholar 

  52. 52.

    Physical Activity Amount. In: Physical Activity Guidelines Advisory, Committee Report. To the Secretary of Health and Human Services. 2008. https://health.gov/paguidelines/report/pdf/CommitteeReport.pdf. Accessed 2 May 2018.

  53. 53.

    Sarna S, Sahi T, Koskenvuo M, Kaprio J. Increased life expectancy of world class male athletes. Med Sci Sports Exerc. 1993;25:237–44.

    Article  PubMed  CAS  Google Scholar 

  54. 54.

    Kettunen JA, Kujala UM, Kaprio J, Bäckmand H, Peltonen M, Eriksson JG, et al. All-cause and disease-specific mortality among male, former elite athletes: an average 50-year follow-up. Br J Sports Med. 2014;49:893–7.

    Article  PubMed  Google Scholar 

  55. 55.

    Lai D, Guo F, Hardy RJ. Standardized mortality ratio and life expectancy: a comparative study of Chinese mortality. Int J Epidemiol. 2000;29:852–5.

    Article  PubMed  CAS  Google Scholar 

  56. 56.

    Anders Ericsson K. Deliberate practice and acquisition of expert performance: a general overview. Acad Emerg Med. 2008;15:988–94.

    Article  Google Scholar 

  57. 57.

    Wen CP, Wai JPM, Tsai MK, Chen CH. Minimal amount of exercise to prolong life: to walk, to run, or just mix it up? J Am Coll Cardiol. 2014;64:482–4.

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors thank the Institute National du Sport de l’Expertise et de la Performance (INSEP) for its full support and Stacey Johnson for carefully checking English spelling.

Funding

This work was supported by grant from the Ministry of sports, youth, popular education and community life of France (Project no. 12-R-10).

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Correspondence to Juliana Antero-Jacquemin.

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Antero-Jacquemin, J., Pohar-Perme, M., Rey, G. et al. The heart of the matter: years-saved from cardiovascular and cancer deaths in an elite athlete cohort with over a century of follow-up. Eur J Epidemiol 33, 531–543 (2018). https://doi.org/10.1007/s10654-018-0401-0

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Keywords

  • Mortality
  • Athletes
  • Cardiovascular
  • Cancer
  • Years-saved
  • Years-lost