Pantani death raises questions

By Charlie Henderson

Pantani's send-off belies a tragic end to a troubled life

Marco Pantani's funeral will be attended by up to 40,000 mourners on Wednesday.

In stark contrast, Johan Sermon's passing mustered little fanfare in the media.

But his death remains equally significant as that of Pantani.

The Belgian cyclist died two days before Pantani, and, like the Italian, an autopsy highlighted apparent heart failure.

Sermon, who died in his sleep, was 21. Pantani was 34.

Their premature deaths take the total of elite cyclists to have suffered heart attacks in the last 13 months to eight. Four have been under the age of 24.

"The statistics appear to be well above average," John Brewer, Head of Human Performance at Lilleshall's Sports Injury & Human Performance Centre, told BBC Sport.

Although there is no evidence linking the cluster of deaths to drug use, a culture of controversy is endemic to cycling and they have sparked suspicion.

RECENT HEART ATTACK VICTIMS Denis Zanette (Italy) 11 January 2003; aged 32 Marco Ceriani (Italy) 5 May 2003; aged 16 Fabrice Salanson (France) 3 June 2003; aged 23 Marco Rusconi (Italy) 14 November 2003; aged 24 Jose Maria Jimenez (Spain) 6 December 2003; aged 32 Michel Zanoli (Netherlands) 29 December 2003; aged 35 Johan Sermon (Belgium) 12 February 2004; aged 21 Marco Pantani (Italy) 14 February 2004; aged 34

"I know that after this death people will talk inevitably about drug use," said Ernest de Vuyst, manager of Sermon's Daikan team.

The spectre of drugs, particularly EPO, looms large in cycling.

"The fundamental issue is that the people who suffer a greater risk of a heart attack are those who are sedentary," Brewer told BBC Sport.

"Conversely, in people who are regularly involved in sport and exercise, even vigorous exercise where the heart is being taxed to a higher level, you would expect to see a below average risk of heart attack.

"The heart is one of the most adaptable muscles in the body and it is unlikely that it will have been weakened by the training. It will adapt and strengthen."

It is a line supported by the British Heart Foundation, which describes strenuous exercise as "highly unlikely" in being a cause for heart attacks.

"The link the cynics would make is whether the deaths are related to drug taking," Brewer adds.

"Anabolic steroids, human growth hormone and EPO have all been linked to an increased risk of heart attack.

"EPO increases viscosity and can lead to higher pressure on the left ventricle which can lead to left ventricular failure."

EPO EXPLAINED Erythropoietin is a hormone naturally produced by the kidneys and can be artificially produced to aid the performance of endurance athletes

There is circumstantial evidence of a cluster of deaths in the sport among Dutch and French cyclists between 1987 and 1991 being linked to the alleged advent of EPO in cycling.

"However, you can put two and two together and come up with the wrong answer," Brewer added.

"There was an increased incidence of heart attacks among Swedish orienteers some years back.

"There was talk of skull-duggery but it turned out that there was a virus that had gone through the squad. It had a debilitating effect on the heart muscle and weakened it, resulting in death.

"There could be another equally plausible reason like a hereditary condition such as hypertrophic cardiomyopathy - an enlarged heart - which can be made worse by exercise, as in the case of Cameroon footballer Marc-Vivien Foe.

"Although if these men had had genetics for a high-disposition to heart attacks it is unlikely they would have become elite cyclists."

Critics suggest cycling's governing body has turned a blind eye to the issue of drug use, despite taking a more hard-line attitude in recent years.

With investigations still ongoing, the World Anti-Doping Agency refused to comment on the deaths, as did the International Cycling Union.

Cycling to sign drugs code

But Wada was keen to highlight that the UCI had agreed to sign up to its code of conduct in time for the Olympics.

For some that may prove too late.