A soldier has up to six times more chance of dying from sudden cardiac arrest than an elite athlete. Not because they have a weaker heart, but because they train and fight in conditions that no stadium would allow: extreme heat, altitude, freezing cold... with no possibility of stopping the match. The European Association of Preventive Cardiology (EAPC) of the ESC has just published the first international guide to try to stop these preventable deaths, and offers very striking data.
According to the data collected in the statement, the incidence of sudden cardiac death in military recruits ranges between 8 and 11 cases per 100,000 recruits per year. In competitive athletes, that figure drops to 1-2 cases per 100,000 athlete-years. That is, a recruit is between 4 and 11 times more likely to suffer such an episode than an athlete, with an average of about 6 times higher risk.
The document, prepared by a committee of international experts from Europe, North America and Australia, is published in the European Journal of Preventive Cardiology.
Studies cited by the authors reinforce this pattern. A large US military study found a sudden death rate of 6.7 per 100,000 person-years in men and 1.4 in women, with cardiac origin in 79% of cases. Another study, on over 220,000 military personnel, raised the cardiac arrest rate to 10.8 per 100,000 person-years. In Israel, a 30-year follow-up of military personnel identified cardiac causes as the primary responsible for these deaths, with 47% of cases.
Among recruits in training, a 25-year review in the United States revealed that 86% of non-traumatic deaths occurred during physical exercise, and that half had a cardiac origin confirmed by autopsy: coronary artery anomalies, myocarditis and hypertrophic cardiomyopathy top the list of causes.
You can read the full study published by the European Journal of Preventive Cardiology.
Comparison between the Army and sport
Only 71% of countries examine the hearts of their recruits with ECG
Despite this difference in risk, a recent EAPC survey of physicians responsible for cardiovascular screening in 14 countries across four continents showed a notable lack of uniformity. Although 79% of armies evaluate all their recruits before entry, only 71% include a 12-lead electrocardiogram in that process, even though this test multiplies by five the sensitivity of a simple health questionnaire in detecting abnormalities.
Recommendations of the new guide
The consensus statement proposes that every new recruit, regardless of their role, undergo a cardiac evaluation that includes a health questionnaire, physical examination and resting electrocardiogram. This screening must be mandatory for those in high-risk positions, such as those working in extreme environmental conditions.
Military personnel aged 40 or older
For military personnel aged 40 or older, the authors add an additional step: assessment of cardiovascular risk using validated calculators, complementary to standard screening. In case of abnormal findings, the guide recommends evaluation by a multidisciplinary team, which may include echocardiography, stress testing or other imaging tests as appropriate.
"The published statement establishes a standardized approach for cardiovascular screening in the military, aiming to foster ECG-based screening algorithms and promote consistency to improve early detection of life-threatening conditions," concludes Dr. Abela.
Source: European Journal of Preventive Cardiology / European Association of Preventive Cardiology (ESC), July 1, 2026.
