Physiologic and clinical triggers, including mental stress, anxiety, and anger, often precipitate acute
myocardial infarction and cardiovascular death. Sporting events can acutely increase cardiovascular event and death rates. A greater impact is observed in patients with known
coronary artery disease and when stressful features are present, including a passionate fan, a high-stakes game, a high-intensity game, a loss, and a loss played at home. Sporting events affect cardiovascular health through neuroendocrine responses and possibly an increase in high-risk behaviors. Acute mental stress increases the activity of the hypothalamic-pituitary-adrenocortical axis and the sympathetic-adrenal-medullary system while impairing vagal tone and endothelial function. Collectively, these mechanisms increase myocardial
oxygen demand and decrease myocardial
oxygen supply while also increasing the risk of arrhythmias and
thrombosis. Measures can be taken to reduce cardiovascular risk, including the use of beta-blockers and
aspirin, stress management,
transcendental meditation, and avoidance of high-risk activities, such as smoking, eating fatty foods,
overeating, and abusing alcohol and
illicit drugs. Sporting events have the potential to adversely affect spectators' cardiovascular health, and protective measures should be considered.