This study addressed the popular misconception that organized marathons are associated with an increase in cardiac sudden death. Marathons that had two decades of history and were conducted on public roads in the United States (1975-2004) with at least 1,000 participants were included in this analysis. For a total of 3,292,268 runners, 26 sudden cardiac deaths were observed, equivalent to a frequency of 0.8 for every 100,000 participants. The typical participant with sudden cardiac death was a middle-aged adult man (average 41 years). Among 24 available autopsy results, the most common finding was atherosclerosis (21%). The final 1.6 km of the marathon accounted for almost 50% of sudden cardiac deaths. During these marathon races, the ratio of motor vehicle crashes prevented was about 1.8 for each case of sudden cardiac death reported among runners. Thus, the relative risk of sudden death in organized marathons is smaller than the risk of a motor vehicle fatality on the same roads during the same time interval. This absolute risk is much lower than that estimated by previous small studies and is in direct contradiction to reports by news outlets and the media.
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