Victim of a heart attack, Uini Atonio, 35-year-old French XV player, will no longer take to the field. A shock for the supporters, but also a recurring question: how can a very high level athlete, medically monitored and trained to the extreme, be the victim of such an event? Dr. Gérald Kierzek, emergency physician, sheds light on the mechanisms at play.
Top athletes are not “protected” by their physical condition
First thing to know, contrary to popular belief, physical excellence and monitoring of athletes do not provide immunity against heart attacks.
“Even with recent normal exams, intense exercise can trigger a cardiac event in an underlying lesion”explains Dr Gérald Kierzek. “The heart of an athlete is very efficient, but it can also mask certain pathologies”.
In athletes under 35, cardiac events are most often linked to cardiomyopathy or structural abnormalities. But beyond this age, the profile changes radically.
After 35 years, coronary heart disease becomes the main cause
In athletes over the age of 35, atherosclerotic coronary artery disease represents approximately 80% of cardiac events.
“These are cholesterol plaques that gradually form in the arteries of the heart, says Dr. Kierzek. Under the effect of extreme stress – maximum effort, spikes in blood pressure, sudden acceleration in heart rate – these plaques can rupture and cause a heart attack.”
In disciplines such as rugby, significant mass gain and intensive training also promote hypertrophy of the heart, often called “athlete’s heart”.
“This hypertrophy can mask coronary lesions, especially since chronic inflammation and oxidative stress linked to intensive training accelerate atherosclerosis”he emphasizes.
Increased risk during intense exercise
That’s not all: according to figures from cardiologists, the risk of heart attack is multiplied by 4 to 5 during maximum effort compared to rest. This is precisely what makes these events so brutal among elite athletes.
“The effort acts as a trigger, explains Dr. Kierzek. A tachyarrhythmia, angina or heart attack can occur suddenly, sometimes as soon as you warm up.”
In the case of Uini Atonio, the onset of early chest pain allowed rapid treatment, avoiding a more serious outcome.
Why medical exams can be missed
Of course, professional athletes benefit from rigorous medical monitoring: ECG, cardiac ultrasounds and regular stress tests. However, these examinations have their limits.
“Resting exams are good at detecting structural abnormalities, but they may miss early atherosclerosis, coronary spasms, or certain rhythm disorders, such as right ventricular dysplasia,” specifies the doctor.
Even the stress test may be insufficient if not performed at true maximum intensity. “Among high-level athletes, it is sometimes necessary to go further, with examinations such as the coroscanner, which is a very good tool for screening the coronary arteries.”he adds.
Sport does not compensate for poor diet either.
Finally, the last key point raised by this case: food. Knowing that the athlete admitted to bad eating habits, such as ordering three menus per trip to the fast food restaurant.
“Sport generally reduces cardiovascular risk by 30 to 50% compared to a sedentary lifestyle., thanks to a better lipid profile and better insulin sensitivity,
reminds Dr. Kierzek all the same. But it does not cancel out the effects of an unbalanced diet.
Excessive consumption of fast food, rich in saturated fats and sugars, accelerates atherosclerosis, even in an athlete who burns a lot of calories.
In some powerful athletes, such as rugby props, visceral obesity can persist despite extreme activity levels.
What the case of Uini Atonio reveals
Hospitalized in intensive care in a stable condition, Uini Atonio benefited from rapid treatment, decisive for his prognosis. For Dr. Kierzek, his case highlights several major lessons:
- The need for more in-depth coronary assessments after the age of 35 (calcium score, coroscan, cardiac MRI);
- The importance of appropriate nutritional support, even for athletes with very high energy needs (5,000 to 8,000 kcal per day),
- And the fundamental reminder that high-level sport remains an extreme constraint on the body, not an absolute guarantee of protection.
This type of accident reminds us that the heart, even when trained, has its limits. Performance must never overshadow prevention.