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Randy Oldman wrote:

Over the age of 35, sudden death in athletes is generally caused by the same things that trigger cardiac events in general,” says Nair, a veteran of four marathons. Rosenblatt, a lifelong runner who has also done half-Ironman triathlons, agrees. “The most likely reason is coronary artery disease,” he says, “especially if you’re a man, just like it is for everyone of that age group, because it’s so rampant in our culture. Probably 50 percent of the population have plaque in their heart arteries by that age.” This scenario, for example, applies to former elite marathoner Alberto Salazar, age 48, who had a near-fatal heart attack in June, and former national-class marathoners such as Andy Palmer and Ed Sheehan, both of whom died on a run despite being highly fit masters runners.

“Under the age of 35, things are different,” says Nair. “Then it’s usually caused by a structural problem with the heart.” The leading causes among endurance athletes for this age group are:

Hypertrophic cardiomyopathy. This is abnormal thickening of the heart muscle. Because of the excessive thickness, problems can occur as blood leaves the heart.

Coronary anomalies. This is being born with heart arteries that don’t take the normal course to the heart. As a result, the heart can act as if arteries are blocked, and heart rhythm problems can develop.

Congenital aortic stenosis. This is being born with two rather than three heart valve leaflets. In some people with this condition, the leaflets can’t open well and the heart can’t force blood out, especially when the person is dehydrated.

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