A man holds a football and watches TV with two men.
Bad pass? Simmer down. Emotional stress can trigger a cardiovascular, game-day disaster. (For Spectrum Health Beat)

Tailgate parties are kicking off the National Football League’s regular season, and if the brats and burgers, cheese dips and chili bowls aren’t enough to give passionate sports fans heart problems, all the close calls and tense final moments of upcoming games just might.

Football fans aren’t the only ones at risk. Some studies have shown sporting events like World Cup soccer and the Rugby World Cup can lead to arrhythmias for certain die-hard fans and, in some cases, heart attacks. Over the summer, numerous World Cup spectators tweeted about getting warnings from their smartwatches over heart rate spikes recorded during soccer matches.

That reaction usually happens when there’s an emotional connection to a game, said Dr. Robert Kloner, chief science officer of the Huntington Medical Research Institutes in Pasadena, Calif.

“When there is an emotional attachment, there can be emotional stress, and emotional stress is one of the triggers of cardiovascular events,” he said.

Turn up a game’s intensity or throw in a contest between longstanding rivals and the heart-breaking conditions absolutely ripen.

“You essentially get a fight-or-flight response,” said Kloner, a professor of medicine at the University of Southern California in Los Angeles.

“What happens? The sympathetic nervous system gets stimulated and there’s a release of catecholamines (hormones), like adrenaline,” he said. “Heart rate and blood pressure go up. The contractility of the heart goes up. All of those things contribute to an increase in oxygen demand.”

And all of those elements can lead to heart problems.

In 2009, Kloner published a study that looked at heart-related deaths following two Super Bowl games involving Los Angeles teams. Researchers found death rates from heart attacks and ischemic heart disease in the city increased in 1980 after the Rams lost an intense championship match to the Pittsburgh Steelers.

In contrast, a Raiders victory in the 1984 Super Bowl against the Washington Redskins was associated with a decline in deaths from any cause.

A big factor in whether a sports enthusiast suffers heart problems during an intense game may be the person’s health status, said Dr. David Waters, a cardiologist and professor emeritus at University of California, San Francisco.

“The prototypical sports fan is overweight, he’s sedentary, doesn’t exercise much, maybe has high blood pressure,” Waters said. “He’s older, a male and has a lot of cardiovascular risk factors to begin with, in other words.”

Many sporting events also take place in extreme weather, he said. The cold that cloaks a Packers fan trying to watch a game during a snow storm in Green Bay, Wisc., for example, can easily contribute to the kind of stress that leads to a heart attack or stroke.

“There’s a confluence of several different things that increase your risk at that particular moment,” Waters said.

So how can passionate sports fans protect themselves during heated games? They should reach out to their doctor if they know they get easily excited. They also should start better addressing any heart disease risk factors they have.

“So that means don’t smoke. Modify food intake. Watch your cholesterol. Be on a statin if you need to,” Kloner said. “Make sure your blood pressure is under control. Keep your diabetes in check. Those are the risk factors that we know we can modify.”

Waters agreed. But he added that taking some risk isn’t entirely bad for the heart.

“Life in general is stressful. There’s good stress and bad stress and if you avoided everything in life that could give you a heart attack, you’d have a very boring life,” he said.