Objective:

To synthesize current evidence on the incidence, demographic characteristics, etiological spectrum, and temporal features of cardiac arrest and sudden cardiac death (SCD) during marathon running, emphasizing risk perception and preventive strategies.

Key Findings:

• Risk of SCD is higher in men, older runners, and full-marathon participants, with implications for targeted prevention strategies. Most SCD events occur in the final phase of the race or shortly after finishing. Coronary artery disease is the predominant cause in middle-aged and older runners, while inherited cardiomyopathies and congenital coronary anomalies are more relevant in younger athletes. Current preventive approaches include cardiovascular screening, electrocardiography, and rapid on-site resuscitation systems.

Interpretation:

Despite the low absolute risk of SCD in marathon runners, the catastrophic nature of these events necessitates improved understanding and targeted preventive strategies.

Limitations:

• Existing reviews often conflate marathon-specific data with broader athletic cohorts, which may skew findings. There are controversies regarding optimal screening intensity and interpretation of subclinical findings, impacting the reliability of recommendations. The review did not apply a formal risk-of-bias instrument or perform meta-analysis, limiting the robustness of conclusions.

Conclusion:

Future efforts should focus on precision risk stratification, longitudinal evaluation of cardiovascular abnormalities, and standardized emergency preparedness for long-distance running, addressing the urgent need for improved safety measures.