Cardiovascular diseases and risk factors associated with sudden cardiac death in amateur athletes: a scoping review

Background: Sudden cardiac death (SCD) is a rare but devastating event in the sports setting, often affecting apparently healthy and physically active individuals. Although regular physical activity is widely promoted as a protective factor against cardiovascular disease, cases of SCD continue to be reported not only in elite athletes but also in amateur and recreational athletes, who frequently lack systematic cardiovascular screening. Objective: To map the available evidence on the most prevalent cardiovascular diseases and the associated risk factors related to sudden cardiac death in amateur athletes. Methods: A scoping review was conducted following the PRISMA-ScR guidelines and the methodological framework proposed by the Joanna Briggs Institute (JBI). The research question was structured using the PCC framework (Population: amateur athletes aged ≥18 years; Concept: cardiovascular diseases and associated risk factors; Context: sudden cardiac death). Systematic searches were performed in PubMed, Scopus, SciELO, and Springer, with no restrictions on publication date and including studies published in English, Spanish, and Portuguese. Study selection, data extraction, and methodological quality assessment were independently performed by two reviewers, with disagreements resolved by a third reviewer. Methodological quality was assessed using JBI critical appraisal tools for observational cohort studies. Results: A total of 1,807 records were identified, of which five observational studies met the inclusion criteria. The most frequently reported cause of SCD in amateur athletes was hypertrophic cardiomyopathy, followed by atherosclerotic coronary artery disease-particularly in athletes older than 35 years-and myocarditis, mainly in younger individuals with recent respiratory infections. Football was the sport most commonly associated with SCD events. The main risk factors identified included male sex, intense physical exertion, traditional cardiovascular risk factors (smoking, hypertension, dyslipidemia, prior myocardial infarction, and coronary stenosis), family history of premature coronary disease, and the absence of early cardiopulmonary resuscitation or defibrillation at the event site. Overall methodological quality ranged from moderate to high. Conclusion: Sudden cardiac death in amateur athletes is predominantly associated with underlying cardiovascular diseases, particularly hypertrophic cardiomyopathy, and with a combination of modifiable and non-modifiable risk factors. These findings highlight that SCD is not exclusive to elite sports and underscore the need for preventive strategies in amateur athletes, including cardiovascular screening, risk factor control, education in cardiopulmonary resuscitation, and availability of automated external defibrillators in sports settings.