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Now to a different kind of health story. Football fans are gearing up for Super Bowl Sunday. And just in time, The New England Journal of Medicine is playing spoil sport with a study on the hazards of being a fan.

NPR's Richard Knox reports.

(Soundbite of fans cheering)

Unidentified Woman #1: Take it up Salem(ph). Take it up.

Unidentified Woman #2: Go get them (unintelligible).

Unidentified Woman #3: Shoot it. (Unintelligible).

RICHARD KNOX: These fans are really into the game, in this case, a youth hockey match in Saugus, Massachusetts.

(Soundbite of fans cheering)

KNOX: Jim Madison coaches a youth hockey team in Andover, Massachusetts.

How emotional do people get?

Mr. JIM MADISON (Hockey Team Coach): Very emotional. It's like the Stanley Cup every game. In a close game, it's exciting. It's just part of the game. It always happens, it seems like, in this game because of the contact, and the physical play, and referees calling things. And you lose a shootout, it's heartbreaking. You play a good game, and it all comes down to that. The heartbeats go right up.

KNOX: That thrill, that involvement, is what being a fan is all about. That's true whether you're a hockey parent of a diehard fan of pro soccer or football. But German cardiologist Gerhard Steinbeck wondered whether there's a downside, a higher risk of heart attacks and cardiac arrest. Earlier studies produced mix results, but the 2006 World Cup soccer games in Germany gave Steinbeck and his colleagues a perfect opportunity to test the theory.

Doctor GERHARD STEINBECK (Cardiologist): These were really extraordinary events in Germany - the national team playing, putting the whole nation in stress.

KNOX: The researchers monitored Munich-area hospitals for heart attacks, chest pain, and major heart-rhythm disturbances during the World Cup games. They compared heart emergencies on days when Germany played, and days when they didn't, and similar periods in other years. The results were striking.

Dr. STEINBECK: There was a penalty shootout in the game against Argentina, and Germans where very lucky to win this game, so we all just were happy, and apparently, you have to pay for that.

KNOX: Within two hours of the start of the game, heart attacks and other cardiac problems spiked.

Dr. STEINBECK: We saw a three to fourfold increase in the number of cardiovascular events.

KNOX: A week later, Germany lost to Italy.

Dr. STEINBECK: And of course, this was a very bad experience. Nevertheless, the increase in the cardiovascular events was exactly as high as when Germany beat Argentina. So it's not winning or losing. It's just the stress produced by both these games.

KNOX: On days when Germany played, cardiac emergencies were nearly three times higher. Men were apparently more vulnerable, so were those with known heart trouble. On days when Germany played, nearly half the cardiac emergencies were among people with prior heart disease, much higher than on other days.

Dr. Robert Kloner is a heart specialist at Good Samaritan Hospital in Los Angeles. He showed a similar spike in cardiac problems in the wake of L.A.'s Northridge earthquake in 1994. You'd think being in a major earthquake would be a different order of stress than watching a big game, not necessarily, says Kloner.

Doctor ROBERT KLONER (Heart Specialist, Good Samaritan Hospital): The fans are emotionally connected to the team. And I think what happens is there is a sympathetic surge that occurs in the fans.

KNOX: Sympathetic, not only in the usual sense, but because the sympathetic nervous system, which controls the body's reaction to stress, leaps into action.

Dr. KLONER: So heart rate goes up, blood pressure goes up. This increases the oxygen demand on the heart. Coronary arteries can actually decrease in size. So at the same time you have an increase in oxygen demand, you have a reduction of oxygen delivery, which is, you know, a bad thing.

KNOX: Peter Libby is chief of cardiovascular medicine at Brigham and Women's Hospital in Boston. He was in Europe during the '06 World Cup games.

Doctor PETER LIBBY (Chief of Cardiovascular Medicine, Brigham and Women's Hospital): Having witnessed the crowd's responses in World Cup playoffs, I'm not at all surprised by the results. That's the fighting spirit, much like we in Boston will have during the Super Bowl.

KNOX: So what about the Super Bowl? Is it hazardous to some fans' health? Clearly, lots of excitable sports fans don't have heart attacks. Kloner looked for a spike in heart attacks in Los Angeles during Super Bowl games from 2000 to 2004.

Dr. KLONER: We didn't see anything. There was not even a hint of a signal of an increase of cardiovascular events around the Super Bowl.

KNOX: He admits that doesn't prove anything. The L.A. area hasn't had a pro football franchise since 1994.

Richard Knox, NPR News, Boston.

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