Watching the World Cup can be stressful.
Stress may cause a heart attack.
Ergo, watching the World Cup may cause a heart attack.
Seems logical. And thus researchers have long been fascinated with this question—whether or not watching sports causes heart attacks. The medical literature on this not thin, and the results would appear to be mixed. I think the answer is basically yes, but let’s take a look, as we head into the Finals this weekend.
On one hand, you’ve got the classic New England Journal of Medicine study from Germany in 2006, which found that the occurrence of stressful soccer matches were associated with more than a two-fold increase in the risk of an acute cardiovascular event at the population level.
The study had some interesting wrinkles, though. The comparison period was the same time of year in 2003 and 2005, but not 2004 (because of the European Cup in 2004, which was held at a similar time that year). But I’d be interested in 2004 outcomes as well. Some people care a lot about the European Cup. (I am not one of them.) But because not as many people care about the European Cup as the World Cup, there might have been a smaller increase in cardiac events in 2004, but still more than 2003 and 2005. This would support a “dose-response” relationship. In fact, the researchers found some degree of a dose-response relationship elsewhere in the study. Rates of cardiovascular events were higher during the World Cup than the control periods and even higher on days when the team from Germany was actually playing. On top of that, the rates peaked an hour into the match, when things can get very stressful. (Or maybe it was beer. Who knows?) That said, despite the seriousness of the topic overall, the level of detail in this paper can only be described as somehow amusing and, also, rather German.
The nation of Sweden has also provided some interesting data on this topic. In their study of cardiovascular risks at various conspicuous times—the SWEDEHEART study (props for the name, at least)—epidemiologists found that the holidays and possibly the Olympics were times of increased risk, though not the World Cup. Well, let’s just say it: Sweden just is not as good as Germany at soccer. So, people probably care less. See where I’m headed?
Finally, we come to Poland. In a study from that fine nation, there was no change in the rates of cardiovascular events during the 2018 World Cup. Of note, Poland did not advance out of the Group stage that year. The most excitement and stress would indeed be expected during the knock-out rounds (the round of 16, quarterfinals, semifinals, and finals), which the team from Poland did not advance to. No particularly high-stakes matches, no increase in cardiovascular events.
All told, I’m convinced that the stress of watching a sporting match can contribute to an increased risk of a major cardiovascular event, particularly when the viewer has a lot emotionally invested in it. If that’s you, please don’t ignore your symptoms! The trick, though, is to watch and enjoy the match, but not to care that much.
Note: I drafted most of this piece a couple of weeks ago, and anticipated publishing it today. In the meantime, the beloved soccer journalist Grant Wahl died of a spontaneous tear to his aorta while covering the World Cup in Qatar. Though that is not a heart attack, ruptured aortas are devastating cardiovascular events, and some of the data discussed above might include such cases. So, notwithstanding the at-times lighter tone of this essay (on what is in reality a serious topic), Grant was on my mind as I completed and edited this piece. I never actually met Grant, but his wife Dr. Céline Gounder is a friend and colleague of mine. As a master of medicine and public health—and Grant’s spouse—I know Céline wants people to enjoy this game, and also look after their bodies. Below is a note from Céline, and a link to two charities that she has asked people to donate to, in lieu of flowers. Thanks for reading.
I wonder what the numbers needed to treat would be if we offered prn propranolol for people at highest risk??
I think we all know the archetype - middle to older aged men who live and die by every play, especially during football games.
It would also be interesting to parse the numbers in these studies by subjects coincidentally on beta blockers for hypertension versus not.
I'm thinking I'll try this the next time I'm really invested in a team winning... which is pretty much my daughter's middle school basketball team since I find professional sports much too commercial anymore!
Any studies on Brazil? That country is heavily invested. On the day they lost, I was on a zoom with a friend in Brazil who was explaining it to me. People were literally in streets and bars crying.