One of the most startling and unexpected events in sports is the sudden death during the play of a young athlete. Herodotus recorded the death of the Athenian’s fleetest runner, Pheidippides, who had been sent to seek help from Sparta during the Persian invasion; he ran 167 miles to reach the Spartans, the raced back to the Athenians with the news that the Spartans had refused to help. He then fought in the Battle of Marathon, in which the Greeks triumphed over the Persians. As soon as the victory was secured, he ran 26 miles at top speed to bring the Athenians the wonderful news. On arriving, he gasped out his message, “We have won!” and fell down dead-but his feat inspired the 26.2-mile footrace we call the marathon today.
Young male athletes are particularly vulnerable to cardiac arrest as a consequence of several kinds of congenital heart disease which produce fatal arrhythmias during games. A congenital abnormality in the heart’s electrical system (which produces a regular heartbeat and an orderly excitation of the heart muscle) predisposes them to disturbances in cardiac rhythm. These patients can experience sudden death, particularly during competitive sports. Other fatalities are due to a disorderly growth of the heart muscle itself. For example, some parts of the heart’s septum, which is proportionately large and actually prevent blood from leaving the chamber when the heart contracts. There is also an illness called Marfan’s syndrome, in which patients are unusually tall and have weaknesses in the wall of their aorta, which can rupture when blood pressure rises during a game.
Some players who are victims of sudden death during sports events have undiagnosed inflammation of the heart muscle due to a viral illness called myocarditis. Myocarditis was in 6 to 7 percent of competitive athletes6 and 20 percent of military recruits who had sudden cardiac deaths.7 An article by Paul Gardner, who reported on the deaths of three soccer players between the ages of 16 and 26 in September of 2007, points out that about 1,000 players a year die from sudden cardiac death. Exhaustion due to the increased rate of speed of play as well as the higher number of games played by each competitor also can end in a fatal outcome. Gardner quotes the assertion of former French soccer star Michael Platini that soccer is characterized by “a relentless drive to play more games …’ we all want to play less but… the system is made so that the players play more and more.” Body contact is now more severe; the size and weight of players have increased over the past 40 years.
6. B.J. Maron, K. P. Carney et al., “Relationship of race to sudden cardiac death in competitive athletes with hypertrophic cardiomyopathy” Journal of the American College of Cardiology 41 (2003): 974.
7. R. Eckart, S. L. Scoville et al., “Sudden death in young adults: A 35-year review of autopsies in military recruits,” Annals of Internal Medicine 141 (2004): 829.
Marianne J. Legato, MD, Ph. D. (hon. c.), FACP is an internationally renowned academic, physician, author, lecturer, and pioneer in the field of gender-specific medicine. She is a Professor Emerita of Clinical Medicine at Columbia University College of Physicians & Surgeons and an Adjunct Professor of Medicine at Johns Hopkins Medical School. Dr. Legato is also the Director of the Foundation for Gender-Specific Medicine, which she founded in 2006 as a continuation of her work with The Partnership for Gender-Specific Medicine at Columbia University. She received an honorary PhD from the University of Panama in 2015 for her work on the differences between men and women.
At its core, gender-specific medicine is the science of how normal human biology differs between men and women and how the diagnosis and treatment of disease differs as a function of gender. Dr. Legato’s discoveries and those of her colleagues have led to a personalization of medicine that assists doctors worldwide in understanding the difference in normal function of men and women and in their sex-specific experiences of the same diseases.
She began her work in gender-specific medicine by authoring the first book on women and heart disease, The Female Heart: The Truth About Women and Coronary Artery Disease, which won the Blakeslee Award of the American Heart Association in 1992. Because of this research, the cardiovascular community began to include women in clinical trials affirming the fact that the risk factors, symptoms, and treatment of the same disease can be significantly different between the sexes. Convinced that the sex-specific differences in coronary artery disease were not unique, Dr. Legato began a wide-ranging survey of all medical specialties and in 2004, published the first textbook on gender-specific medicine, The Principles of Gender-Specific Medicine. The second edition appeared in 2010 and the third edition, dedicated to explaining how gender impacts biomedical investigation in the genomic era, won the PROSE Award in Clinical Medicine from the Association of American Publishers in 2018. A fourth edition is forthcoming.
She also founded the first scientific journals publishing new studies in the field, The Journal of Gender-Specific Medicine, and a newer version, Gender Medicine, both listed in the Index Medicus of the National Library of Medicine. She has founded a third peer-reviewed, open access journal, Gender and the Genome, which focuses on the impact of biological sex on technology and its effects on human life.
Dr. Legato is the author of multiple works, including: What Women Need to Know (Simon & Schuster, 1997), Eve’s Rib (Harmony Books, 2002), Why Men Never Remember and Women Never Forget (Rodale, 2005), Why Men Die First (Palgrave, 2008), The International Society for Gender Medicine: History and Highlights (Academic Press, 2017), and most recently, The Plasticity of Sex (Academic Press, 2020). Her books have been translated into 28 languages to date.
As an internationally respected authority on gender medicine, Dr. Legato has chaired symposia and made keynote addresses to world congresses in gender-specific medicine in Berlin, Israel, Italy, Japan, Panama, South Korea, Stockholm, and Vienna. In collaboration with the Menarini Foundation, she is co-chairing a symposium on epigenetics, Sex, Gender and Epigenetics: From Molecule to Bedside, to be held in Spring 2021 in Italy. She maintains one of the only gender-specific private practice in New York City, and she has earned recognition as one of the “Top Doctors in New York.”
