Table of Contents
Year : 2018  |  Volume : 3  |  Issue : 2  |  Page : 66-70

Soccer related emotion and stress-induced cardiovascular events

1 Department of Cardiovascular Medicine, Nanchang University, Nanchang, China
2 Boston TransTec LLC, Boston, MA, USA

Date of Web Publication16-Jul-2018

Correspondence Address:
Chunsong Hu
Department of Cardiovascular Medicine, Nanchang University, Nanchang 330006
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/cp.cp_14_18

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Some say soccer is a stimulant and others say that it is a jinx due to the strong excitement and anxiety that players and fans experience during and following soccer matches. Unexpected adverse events related to these emotions have been documented and include major cardiac events and death. For this reason, soccer may be called a “killer” by emotion. This article reviewed the literature for evidence relating to soccer clashes, riots and emotional stress-induced acute cardiovascular events. Mechanisms were also explored, and included blood pressure abnormalities, coronary heart disease, acute coronary syndrome or acute myocardial infarction, arrhythmia, sudden cardiac arrest, sudden cardiac deaths, and stroke.

Keywords: Emotion, games, lifestyle, major adverse cardiac event, soccer

How to cite this article:
Hu C, Tkebuchava T. Soccer related emotion and stress-induced cardiovascular events. Cardiol Plus 2018;3:66-70

How to cite this URL:
Hu C, Tkebuchava T. Soccer related emotion and stress-induced cardiovascular events. Cardiol Plus [serial online] 2018 [cited 2021 Mar 7];3:66-70. Available from:

  Introduction Top

As we all know, soccer and its matches have attracted people and fans due to its unique charm. As the world's most popular sport, it is certain that soccer is beneficial to people's health, not only in theory but also in practice because soccer is an effective form of aerobic exercise.[1] However, some say soccer is a stimulant, while others say it's a jinx. The authors think that soccer is a double-edged sword according to events concerning current soccer scandals and fan riots. Both excessive excitement and anxiety experienced by fans following soccer matches may lead to negative health outcomes and acute cardiovascular events, which include blood pressure abnormalities, coronary heart disease, acute coronary syndrome (ACS) or acute myocardial infarction (AMI), arrhythmia, sudden cardiac arrest (SCA), sudden cardiac deaths (SCD), and stroke. Therefore, soccer may be considered a “killer” by emotion. This article reviews related evidence and possible mechanisms for soccer emotional stress-induced acute cardiovascular events.

  Evidence Top

According to the Fédération Internationale de Football Association (FIFA) officials crisis in June 2015, the reported FIFA corruption scandal not only changed some officials' fates but also discouraged people's feelings and even faith in soccer. According to a poll, 69% of the 25,000 fans from 28 different countries across the globe have no faith in FIFA and do not trust the current football's governing body, and 43% said that their enjoyment of football had been affected by the corruption scandals. At the same time, there are reports on referees' unfair judgements, and some coaches' improper commands and strategies. Therefore, we believe that soccer is a killer of emotion. Second, studies on professional players have confirmed that soccer is a common killer of emotion. According to recent studies on health-related quality of life (HRQOL) during and after a career in professional sport, there are common negative psychological responses to severe injury [2] such as tension, depression, anger, anxiety, and fatigue. Moreover, there are often poorer outcomes in all aspects of HRQOL later in life for these elite athletes. In fact, almost every game brings some frustration to the losing players or fans. Thus, psychological rehabilitation interventions are necessary to address associated adverse behaviors or unhealthy lifestyles such as insomnia, heavy alcohol or smoking, even drug taking or doping. Third, some noncivilized behaviors during soccer matches in both professional football players and many fans confirm that soccer is a typical killer of emotion. For example, there have been 11 incidences of major fan riots from 1950 to 2017, including two in Brazil in 1950 and 2014, and two in Egypt in 2012 and 2015, respectively [Table 1]. There was indeed a tragic incident when a soccer player shots a referee dead and wounded another player following a red card during a game in Argentina on Sunday, February 14, 2016.
Table 1: Major riot or clashes events at Soccer matches in the World since 1950s

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Finally, and most importantly, soccer matches directly affect the emotion of professional players and fans, either by inducing great excitement or creating anxiety within individuals following bad luck and unexpected results in a match. For example, fans have been known to assault the chief-coach or the official website of the soccer association. Especially, during World Cup matches, there are often various unexpected health occurrences. Exercise-related SCD has occurred among players in the recent decade [3]. In addition, due to losses at World Cup matches, many fans have temporarily changed their regular lifestyles and daily schedules, for example, prolonged sitting, sleeping less at night and staying up late, excessively drinking, and gambling. These changes disrupt their biological clocks and change human hormone levels, directly leading to unexpected events and a range of conditions [Table 1]. There have been incidents of a fans committing suicide or divorcing their partner, reflecting dramatic changes in their emotional and psychological stress. In particular Takotsubo syndrome-related AMI or apical ballooning syndrome (Takotsubo or stress cardiomyopathy) is now a common heart disease,[4],[5] which may be triggered by one's emotional or physical stress changes during a soccer match. Moreover, there are a group of patients with hypertension related to “new type stress” due to lasting unhealthy lifestyles which is now called “C-type hypertension.”[6],[7] These patients may be predisposed to AMI,[8] stroke,[9],[10] even SCD due to abnormal blood pressure, lipids,[11] blood sugar, and chronic kidney disease.

  Possible Mechanisms on Soccer Clashes or Riots Top

During the World Cup matches, this phenomenon and cases greatly increase due to unhealthy lifestyles that can sometimes last for a month. For example, chronic anxiety or depression may lead to cardiovascular, diabetes, and cancer strips.[12] To return every 4 years, soccer is a typical killer of emotion. We would like to remind fans to take care and live healthy lifestyles because adherence to a low-risk lifestyle is associated with a low risk of SCD [13] and to adopt a novel management program for hypertension.[14] However, it is an interesting phenomenon that most fans' riots take place in male soccer matches but seldom occur in female ones. This difference may be due to male hormone levels and need to disclose the linkage between hormone and emotion.[15] At the same time, there are other games such as basketball, volleyball, badminton, or table tennis, which has the same or similar riot or clash events with soccer? Although there are also events of large-scale gang fights in men's basketball games in China, recently, these events show that if people cannot keep a normal state of mind or rational attitude of winning or losing, there may lead to clashes at any time among players or fans whether it is football or other games. Recent studies identified the β form of calcium/calmodulin-dependent protein kinase Type II as a powerful regulator of the lateral habenula neuron function and a key molecular determinant of depression [16] and found further that a dorsomedial prefrontal cortex neural population links to the circuit basis of adaptive and pathological social behaviors.[17] In fact, there is a high linkage between emotion and behavior in humans;[18] the lover of soccer among students often did not score highly probably due to soccer-related emotion changing their learning and memory.[19] As a fundamental part of living, studies at the cellular level from animals to humans confirm that emotion links with cognition.[20] SIRT1 activity may play a crucial role in emotional behaviors and human disorders.[21]

  Soccer Emotional Stress-Induced Cardiovascular Events Top

Soccer is the most popular sports in the world, with over 200 million active players. As we known, modest physical activity may reduce cardiovascular risk significantly because physical fitness may confer protection from thrombosis. However, vigorous physical activity such as soccer matches and tournaments, including FIFA World Cup lead to emotional strain and increase the risk of cardiovascular events (CVEs). This occurs especially in cardiovascular high-risk patients or athletes with congenital heart diseases because acute exercise-induced platelet activation may be involved in the triggering of acute vascular events.[22] A study in Germany also confirmed that emotional strain caused by the World Cup is a risk factor.[23] Therefore, an important soccer match is a challenge not only for players and fans but also for football referees [22] and the cardiologist.[24]

Although a single study found that there was a lack of association between watching soccer matches and the risk of acute CVEs,[25] and another found that, during World Cup Soccer 2006, the number of deaths due to myocardial infarction was not measurably increased compared to a matched control period,[26] there are more available published studies regarding the association between soccer matches and the increased risk of CVEs.

A longitudinal population study found that an important soccer match may provoke enough stress to trigger symptomatic cardiovascular disease including AMI and stroke,[27] even SCD due to hypertrophic cardiomyopathy and coronary artery disease.[28],[29] During the World Cup soccer, the risk of acute CVEs doubles, particularly in men with known coronary heart disease who watch a stressful soccer match.[30] There are differences not only between men and women [27] but also between Australians and European populations,[31] for example, one study found that exercise-related severe CVEs are mainly seen in men.[32] Another study found that there was no increase in cerebrovascular events during German World Cup soccer games in 2006,[33] which was probably reflective of health care and the tendency of German people. In addition, there is an increased risk of developing atherogenic and/or cardiovascular events in a group of Cameroonian professional soccer players due to elevated levels of oxidatively modified low-density lipoprotein-C particles.[34] Moreover, there are different incidences in electrocardiogram abnormalities such as a high voltage of the left ventricle in young, elite, Japanese male and female athletes.[35] Early repolarization associated with increased risk of SCD is often found in soccer players.[36] In fact, training and competition lead to similar cardiocirculatory and metabolic stresses which are considerably high and might put players into danger who have preexisting cardiac disease.[37]

Related mechanisms are still not completely clear; however, a study found that emotional stress-induced ACS is associated with a profound increase in inflammatory and vasoconstrictive mediators such as monocyte chemoattractant protein-1 and endothelin-1.[38] Another study found that there is a prolonged elevation of central systolic blood and pulse pressure after emotional stress.[39] Moreover, acute emotional stress may result in initiation of plaque rupture.[40] Sporting events affect cardiovascular health through neuroendocrine responses and possibly an increase in high-risk behaviors and unhealthy lifestyle,[41] which include smoking, eating fatty foods, overeating, and abusing alcohol and illicit drugs. In addition, potential effects of a complex psychosocial phenomenon may be involved.[42] These mechanisms increase myocardial oxygen demand and decrease myocardial oxygen supply while also increasing the risk of arrhythmias and thrombosis. Thus, it is necessary to do appropriate screening following FIFA recommendations [43] and risk stratification for soccer player, referees, and fans during the season of soccer matches. Moreover, health education is very important for earlier recognition of SCA followed by earlier cardiopulmonary resuscitation [44] since SCD is the most common cause of unnatural death in football.[45]

As to related strategies for soccer emotional stress-induced CVEs (ACS, AMI, SCA, SCD, and stroke),[46] on the one hand, we need to change high-risk behaviors and unhealthy lifestyle; on the other hand, international or regional registries to accurately collect data relating to acute CVEs are greatly needed.[47] in addition, emergency preparations, automated external defibrillator supply, rapid resuscitation response, and training of team-staff members are very important. Of course, appropriate drugs such as beta-blockers, statins, and aspirin may reduce the incidence of triggered acute CVEs.[40] Rational and scientific stress management is also useful.[41]

  Conclusion Top

All in all, unhealthy emotion changes the outlook and characteristics of soccer and the matches themselves, and as a scapegoat, soccer in fact becomes a typical killer if people cannot effectively control and express their emotion; people who like and are even infatuated with the sports should not only keep close contact with soccer matches but also keep away from them if they cannot control their emotion. To keep health and family happiness during soccer events [Figure 1], please follow SEEDi 1.0–3.0 strategies for major noncommunicable diseases [6],[48],[49],[50] and be a rational and civilized fan and player when soccer season comes around. As the famous medical expert in China and Academician Nanshan Zhong said, “the greatest success in one's life is to be alive and healthy.” Health has always been a dream from reality to the future.[51] Soccer always emotionally moves the heart of the players and fans and causes people to become infuriated, or even cry. It is really a typical killer of emotion. People should abandon utilitarian thinking so that soccer may return to humanities and nature and truly become a popular favorite entertainment game and physical exercise, rather than a typical killer of emotion. Indeed, the studies on the behavior of large crowds and the medium-term and long-term benefits of the tournament are needed for future soccer event-related mass gatherings.[52] Here, we wish honestly the Russian 2018 World Cup a successful success in advance.
Figure 1: The role of E(e)SEED-related lifestyle on human organs tissues, cells, and genes is shown. Here, E(e): External or internal environment, S: Sleep, Em: Emotion, Ex: Exercise, D: Diet. SEEDi1.0–3.0 strategies were developed for major noncommunicable diseases according to these core elements of health

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The first draft was written in June 28, 2014, during the World Cup soccer matches. The authors gratefully acknowledge editors and reviewers for a critical review.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

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