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The sudden demise of an athlete invariably leads to calls for prevention. Although few screening programmes live up to expectations, the 2005 European Society of Cardiology consensus statement contains a recommendation for routine pre-participation screening of asymptomatic young athletes. As the incidence of sudden cardiac death (SCD) in this group is very low (2 per 100,000 per year), and no test reliably identifies persons at an increased risk of SCD, the Health Council of the Netherlands advised against mandatory screening. It seems prudent, however, to consider other strategies for reducing the occurrence of exercise-related cardiac death, e.g. by stimulating prompt resuscitation efforts and, perhaps also focusing on the rapidly growing group of senior athletes at increased risk of acute cardiac (mainly coronary) events, as this group may benefit from the recent advances in CT imaging of the coronary arteries.