Original Article

The risk of heart disease in women has likely been underes-timated in the past, possibly partly because of a perception that women are protected against cardiovascular disease, par-ticularly in young and middle age groups. Women have been and still are underrepresented in research in many important areas of cardiology, and guidelines often include recommen-dations that are based on research performed predominantly in men.1 Clinical Perspective on p 1191 The medium- and long-term benefits of regular physical exercise on cardiovascular events, including sudden cardiac death (SCD), have been well demonstrated.2,3 However, sports activity itself has been shown to confer some risk, particularly when vigorous exertion is undertaken abruptly by untrained persons, or in the presence of serious underlying heart dis-ease. Recently, we have demonstrated that the majority of sports-related SCDs occurred in middle-aged adults, and that only a minority of such events occurred in young competi-tive athletes4; this latter group, however, has been the focus of the majority of publications until now. Although pres-ports screening strategies have been adopted for many years among young competitive athletes,5 it has been recently sug-gested that preparticipation screening programs might als