Collateral damage.
Watching World Cup soccer appears to increase heart attack risk.

Felix Heyder/epa/Corbis

Soccer: Not for the Faint of Heart

It's not just terrorism and earthquakes that can precipitate heart attacks among the vulnerable. Soccer games do it, too. Researchers at the University of Munich, Germany, found that heart problems more than tripled in German men while their team was playing in the World Cup in the summer of 2006.

Physician Ute Wilbert-Lampen and colleagues analyzed reports of hospitalizations for heart attacks, chest pains, and arrhythmias collected by emergency medical teams on the 7 days that the German team played during the games, which were held around Germany from 9 June to 9 July. They compared the results with reports covering weeks immediately before and after the games as well as from summer months in 2003 and 2005--for a total of 4279 patients.

On the days of matches involving the German team, men in the Munich area experienced 3.26 as many cardiac events as they did during control periods. That's not too far from the fivefold increase reported after a 1994 earthquake in Los Angeles. Women were much less affected, with a cardiac event rate 1.82 times that during control periods. The games especially affected the vulnerable: 47% of the cases involved people with preexisting heart disease, compared with 29% during the control periods.

Various other studies have tried to link soccer madness with heart attacks or mortality, sometimes with conflicting results. For example, a study published in 2003 found a decrease in fatal heart attacks among Frenchmen the day France won the 1998 World Cup.

But Wilbert-Lampen and colleagues say theirs is the first study to track a precise temporal relationship between action on the field and in the chest. They found that the incidence peaked about 2 hours into a match and remained elevated for several hours afterward--indicating that the "acute trigger mechanisms" occur 1 or 2 hours before symptoms appear. Two matches in particular led to spikes in heart hospitalizations--a hard-fought victory over Argentina and an important loss to Italy--proving it's the excitement of the game and not the outcome that causes the intense stress. The team presents its findings in the 31 January issue of The New England Journal of Medicine.

Epidemiologist Diederick Grobbee of University Medical Center Utrecht in the Netherlands says the study strengthens the case for his earlier finding that the incidence of fatal heart attacks among Dutch males jumped significantly on the day of a tense soccer match. Grobbee notes that the patterns both of mortality and of the symptoms in the latest paper indicate that "rather than inducing new events [in people with no known heart trouble], the effect could be that an event that is bound to happen anyway is triggered earlier."