Sudden death due to ischaemic heart disease in young Aboriginal sportsmen in the Northern Territory, 1982‐1996

Abstract

Objective To estimate the incidence of sport‐related sudden cardiac death due to ischaemic heart disease (IHD) in competitive young Aboriginal sportsmen. Setting Northern Territory (NT), 1982‐1996. Design Retrospective case series with cases identified from Australian Bureau of Statistics cause‐of‐death listings and NT coronial autopsy records. Main outcome measures Circumstances and incidence of sport‐related sudden cardiac deaths due to IHD; autopsy findings. Results Between 1982 and 1996, there were eight sudden cardiac deaths due to IHD and related to sporting activity among Aboriginal sportsmen aged 15‐37 years in the NT. Six were associated with games of Australian (rules) football. All occurred in the Top End of the NT in the wet season, and all occurred after the first half, or within an hour of, a game. Four of the players had macrosopic myocardial abnormalities (hypertrophy or previous infarcts) on autopsy. The estimated incidence of I HD‐related sudden cardiac death among Aboriginal Australian football players in the NT was 19‐24 per 100 000 player‐years, compared with 0.54 per 100000 player‐years among Australian rules footballers of similar ages in Victoria. Conclusions Incidence of sudden cardiac death attributable to underlying IHD was extremely high among young NT Aboriginal Australian footballers. Prevention will best be achieved by funding culturally appropriate long‐term strategies to reduce the incidence of IHD. However, in the short‐term, community‐controlled programs with education of athletes, heat‐stress reduction strategies, and cardiovascular screening should reduce the incidence of sudden cardiac death in sport.

Enough! or too much. What is ‘excessive’ kava use in Arnhem Land?

“…Other studies have investigated kava's possible longer-term health effects. For instance, kava has been implicated in serious infectious disease [25] and sudden cardiac death in young Aboriginal sportsmen [28]. However, data not yet published shows that we cannot assert confidently that kava use is associated in the long term with increased risk of ischaemic heart disease morbidity and mortality or pneumonia, (Clough et al, unpublished data).…”

Health effects of kava use in an eastern Arnhem Land Aboriginal community

“…5 Recently it was suggested that kava use may be a risk factor for sudden cardiac deaths among young Aboriginal sportsmen in Arnhem Land populations, especially when coupled with heavy alcohol use. 6,7 Possible mechanisms include abnormal coagulation with enhanced thrombosis, dehydration or arrhythmias. Other health risks for kava users include acute neurological effects 8 and the infectious disease melioidosis, which may be greater among heavy users.…”

Case-control study of the association between kava use and ischaemic heart disease in Aboriginal communities in eastern Arnhem Land (Northern Territory) Australia

“…Heavy kava users may become dehydrated and myocardial ischaemia and sudden cardiac death are possible attributable to abnormal coagulation with increased thrombosis and/or arrhythmias. 2 Acute effects of kava may also be mediated by neurological mechanisms. Large doses of kava pyrones can lead to abnormal atrioventricular function, consistent with kava's well known muscle relaxing properties.…”

“…1 Circumstantial evidence suggests that kava consumption is associated with ischaemic heart disease (IHD) and sudden cardiac deaths among, particularly, young Aboriginal sportsmen in this population. 2 …”