The mood of the nation is buoyant: the national side have returned from the Olympics with plenty of gold. Admittedly, it was disappointing that the soccer team failed to qualify for the European Cup earlier in the summer – but hey, look on the bright side. Failure to qualify allowed the cardiologists and coronary care staff to stand down, if not entirely at least to relax a little, which is probably more than their counterparts in Germany were able to do. Why so? Well, as reported in a venerable ‘red top’ journal, ‘viewing a stressful soccer match more than doubles the risk of an acute cardiovascular event’ (N Engl J Med 2008;358:475–83). Hitherto there had been rumblings in the medical press about the increased incidence of coronary events in association with major sporting tournaments. Watching an important soccer match is associated with intense emotional stress (allegedly), which in turn can trigger acute coronary syndrome and symptomatic cardiac arrhythmias. To put an end to the controversy, a prospective study was conceived in typical thorough and diligent Germanic fashion. It was conducted during the last World Cup, which was hosted in Germany in 2006 – thus putting the home side under even greater pressure to perform. The incidence of cardiovascular events was recorded in Bavaria during the month-long tournament and compared with the incidence of the months either side and with a historical control period. There was nearly a three-fold increase in incidence of events on the days the home side competed and particularly for those games decided by penalty shoot-outs (for the football pundits among the readership the quarter-final draw with Argentina was particularly nail-biting). I dare say the coronary care units were on high alert for this year's semi-final and final. Patients with pre-existing coronary artery disease were most at risk and as must be obvious surely there was a pronounced gender association.

So much for the effect on the hearts of spectators – what about the players? Recent research (Clin Biochem 2008;41:841–51) documents that a game of soccer increases the levels of antioxidants and markers of muscle damage for up to 72 hours after a closely contested game.

Such are the stakes now in sport that there is interest in what constitutes the best genetic make-up for an elite sports man or woman and could there be any way that genetic testing could be exploited to identify the medal winners of the future? A genetically engineered mouse strain has recently been shown capable of being able to run and run (Biochimie 2008;90:838–42). The cDNA for the cytosolic form of the phosphoenol pyruvate carboxykinase (linked to the human alpha-skeletal actin gene promoter) was introduced into the murine germline. The mice expressed 100 times as much enzyme in their skeletal muscle as the control animals and consequently could run for up to 5 km (which is more than a sedentary biochemist could hope to do) at speeds of up to 100 times as fast as controls. A somewhat Frankenstein prospect for the future of athletics…

Ahead of Beijing, a systematic review was published on the clinical consequences of drug abuse in sport (Lancet 2008;371:1872–82). It details the degree of misuse, the evidence that some drugs enhance performance in sport, the side-effects and the long-term consequences. The use of doping agents, particularly anabolic androgenic steroids (AAS) has increased over the last 40 years. In the USA, between one and three million people are thought to have misused AAS. But the original Olympians were not blameless – there are records of consumption of bread soaked in opium, mushrooms and strychnine to improve performance. Athletes have been known to take supraphysiological doses of AAS which as well as their endocrine effects have significant metabolic side-effects. These include increasing LDL cholesterol which will increase the risk of cardiovascular disease and hypertension. There can also be hepatic involvement as manifested by increased aminotransaminases. Analytical methods and laboratories accredited by the World Anti-Doping Agency (WADA) can detect the misuse of all doping agents; although the detection of testosterone is not as straight forward as hitherto thought. The original problem was differentiating between endogenous and exogenous testosterone. This was initially solved by measuring the ratio of urinary testosterone to its naturally occurring isomer epitestosterone as the concentration of epitestosterone is not affected by the intake of testosterone. However, there would appear to be interethnic differences in the metabolism and excretion of testosterone (JCEM 2008;93:2500–6). This is attributed to ethnic differences in the genotype of the glucuronyl transferase enzyme, which is responsible for rendering testosterone water soluble for urinary excretion – this ethnic difference renders the results of the doping test unreliable. Those individuals whose ethnicity predisposes to a deletion polymorphism in the gene for uridine diphosphoglucuronosyl transferase failed to demonstrate a significant increase in urinary testosterone after a testosterone challenge. Using different cut-offs for the testosterone/epitestosterone ratio depending on the presence of certain polymorphisms in the UGT2B17 gene will improve the sensitivity and specificity of the doping test – WADA is distinguishing between exogenous and endogenous testosterone. Neither is there evidence of benefit for some of the other drugs misused by athletes. For example there is no evidence of improvement in athletic performance in taking growth hormone. A systematic review prevalence of misuse, the evidence that some drugs improve performance in sport, their side-effects and the long-term consequences of AAS are reviewed. There is substantial under-reporting of the side-effects of AAS to health authorities, particularly, those associated with violent behaviour.