The relationship between pre-participation screening of young competitive athletes and family screening.

ith great interest we read the review by Corrado et al. (1) on re-participation screening (PPS) of young competitive athletes to revent sudden cardiac death (SCD). It is important that Corrado et al. (1) briefly mentioned the ossibility of cascade screening of relatives of a competitive athlete ith an inherited heart disease. Unfortunately, this topic is requently neglected in articles on PPS. As the authors state, dentifying other affected family members with subsequent highisk stratification and treatment can save additional lives. Hypertrophic cardiomyopathy (HCM), which can be detected y PPS (1), is the most important cause of SCD in young athletes. t present, a mutation is identified in 30% to 61% of HCM atients (2). The identification of a disease causing mutation nables cascade screening within a family. With the developments n diagnostic tools for DNA analysis (e.g., high-throughput echniques), the proportion of mutations identified will probably ncrease. In case no mutation is found (yet) in an HCM patient, ardiological examination of first-degree relatives is the second best ption. One could argue that affected family members identified by ascade screening should be taken more into account when iscussing the efficacy of PPS. In any case, performing cascade creening after identification of an affected athlete by PPS could ontribute to reducing the incidence of SCD in the general opulation. Moreover, implementing and offering an adequate nationwide amily screening program to relatives of young SCD victims or atients with inherited heart disease could indentify most individals and families in the country at risk of SCD. This would otentially decrease the benefit of PPS in competitive athletes, ecause this target group would become an even more selected ealthy population.