**8. Ethnic differences**

There are some ethnic differences in SCD rates depending on its cause. In general, for over 27 years of observation in the USA, white males dominated in a large cohort of athletes who died suddenly (46%), followed by African Americans and other minority (43%), and white and black and other minority females (8 and 3%) [6]. However, an analysis of specifically cardiovascular SCD in those who died from HCM and coronary artery abnormalities revealed significantly higher (more than twofold) rates in African Americans, while Caucasians were still at the top of the list for ARVC and primary electrical diseases (channelopathy). In the European study [21], the range of diseases identified in athletes suddenly dying was almost the same, yet there were significant differences in the frequency of the main variants of myocardial damage; ARVC was detected in 24% of cases, HCM in 2%, and myocarditis in 10%. If the proportion of the three major variants of myocardial damage (ARVC, HCM, and myocarditis), detected in suddenly dying young American and Italian athletes, is compared, similar aggregate values are obtained, namely, 38% in Italy and 46% in the USA. Taking into account all potential ethnic differences or autopsy reports, there may be a different interpretation of similar pathomorphological changes.

Nevertheless, it is obvious that the main risk group for SCD in athletes includes those with life-threatening cardiac arrhythmias and myocardial changes. However,

#### *Sudden Cardiac Death*

the risk of SCD is significantly higher in athletes than in nonathletes with the same heart condition in the general population—by more than 5 times for ARVC, 2.6 times for coronary artery disease, 1.5 times for myocarditis, and more than 2 times for cardiac conduction system diseases [6].
