Heart disease prevalence among former NFL players extremely common
Click Here to Manage Email Alerts
Key takeaways:
- Hypertension, abnormal ECG findings and abnormal echocardiography findings were common in retired NFL players.
- The results raise questions about heart disease screening for people aged 50 years or older.
ATLANTA — A screening study presented at the American College of Cardiology Scientific Session showed that there is a high prevalence of unrecognized heart disease among former National Football League players.
Almost 90% of the former NFL players had hypertension despite few knowing that before the screening, and more than 60% had structural cardiac abnormalities on transthoracic echocardiography (TTE), according to the results, which were simultaneously published in the Journal of the American College of Cardiology.
The screening included former NFL players as well as coaches and family members.
“Based on these data, there is a high prevalence of risk factors, especially uncontrolled blood pressure as well as cardiovascular disease based on TTE in the entire population, and especially among former professional athletes such as American-style football players,” Michael Amponsah, MD, ChB, FACC, interventional cardiologist at Banner Boswell Medical Center in Peoria, Arizona, said during a presentation.
Amponsah said his team undertook the study because little is known about CVD prevalence in retired athletes.
Mitigating CVD consequences
“Professional athletes tend to be perceived as having healthy living habits, but they may be at significant risk for cardiovascular disease at a younger age and in the post-playing years,” Amponsah said. “The HUDDLE study aimed to assess CVD and risk factor prevalence in a representative sample of former NFL players, coaches and family. It also aimed to quantify the knowledge gap of actual vs. perceived CVD and risk factors and engage with participants through education. And finally, to identify opportunities for inclusive screening to mitigate the consequences of cardiovascular disease.”
The cohort consisted of 498 retired NFL players, coaches and family members aged 50 years or older (mean age, 63 years; 67% men; 63% African American or Black) who attended one of nine screening events in 2021 or 2022 and completed a 30-day follow-up phone visit.
In self-reporting before the screening, risk factor history was as follows: hypertension, 41.6% in the overall cohort and 37.5% in former NFL players; high cholesterol, 31.9% in the overall cohort and 32.6% in former NFL players; and diabetes, 11.8% in the overall cohort and 12.6% in former NFL players, Amponsah said.
The prevalence of hypertension, defined as known hypertension, BP greater than 130/80 mm Hg at screening or taking antihypertensive medication, was 89.3% in the overall cohort and 89.8% among former NFL players, he said.
Among those who self-reported no hypertension, 80.1% of the overall cohort and 81.5% of former NFL players had it, and among those who self-reported hypertension, 41.2% of the overall cohort and 36.5% of former NFL players did not have it under control at the time of screening, according to the researchers.
The rate of abnormal ECGs was 37.5% in the overall cohort and 46.1% in former NFL players, and the rate of abnormal findings on TTE per American Society of Echocardiography (ASE) guidelines was 55% in the overall cohort and 61.8% in former NFL players, Amponsah said, noting that there was one critical finding on TTE, a former NFL player who had an abdominal aortic aneurysm and underwent surgery for it.
Even participants with systolic BP less than 120 mm Hg had a high prevalence of abnormal findings on TTE (43.1% in the overall cohort and 64.7% among former NFL players), he said.
Among those with a known history of CVD or risk factors, 76.1% were recommended for follow-up due to hypertension, abnormal ECG findings and abnormal TTE findings, whereas among those with no known history, 56.3% were recommended for follow-up, including 53 participants who had abnormal TTE findings despite no known history, Amponsah said.
Predictors of heart disease
In the overall cohort, independent predictors of a clinically significant structural abnormality on TTE included age as a continuous variable (OR = 1.05; 95% CI, 1.02-1.08; P = .001), male sex (OR for female sex = 0.61; 95% CI, 0.39-0.97; P = .04) and abnormal finding on ECG (OR = 1.56; 95% CI, 1.03-2.37; P = .04), whereas in former NFL players, hypertension at screening was an independent predictor of abnormal TTE findings (OR = 2.02; 95% CI, 1.03-3.96; P = .04), according to the researchers.
“Based on these data, we feel there may be a benefit for TTE screening in individuals over age 50 to assess structural pathologies,” Amponsah said during the presentation.
Reference:
Perspective
Back to Top
The important message about the HUDDLE trial is that even in athletes, primary prevention, evaluating for CVD risk factors including hypertension, is incredibly important. It is often overlooked and undertreated in athletes, just like it is in many other populations throughout the world. This is another study reminding us that even if the patient is a retired athlete at the highest level, you still must talk to them about weight management, nutrition, and treatment of CVD risk factors.
I agree with one of the researchers’ conclusions that there is a clear discrepancy in awareness of hypertension in this community, which presents an opportunity for improvement with a healthy intervention.
The challenging message in this paper for me is my concern surrounding the methods used to collect the data and another conclusion that “Early TTE screening may offer a significant benefit for the over-50 population.” Standard ECG criteria were used for assessment, not athletic-specific criteria, which we know is error-prone and will cause a lot of false positives. Furthermore, ASE guidelines for echocardiography applied to athletes will also cause false positives for left ventricle size, right ventricle size and wall thickness, as examples. False positive findings will lead to downstream complications for those screened, which are worsened using their methods.
There is a burgeoning amount of research that has evaluated and identified this maladaptive profile and already in publication. Jonathan H. Kim, MD, MSc, associate professor of medicine in the division of cardiology and director of sports cardiology at Emory University School of Medicine, Emory Clinical Cardiovascular Research Institute, has written about LV hypertrophy, aortic stiffness and hypertension in collegiate athletes. Dermot Phelan, MD, PhD, FASE, FACC, director of the Gragg Center for Cardiovascular Performance, medical director of cardiovascular imaging and director of the Hypertrophic Cardiomyopathy Center at Atrium Health Sanger Heart & Vascular Institute, has written about the prevalence of atrial fibrillation and aortic size in retired NFL athletes. We wrote a paper on unrecognized hypertension in young collegiate women athletes.
I am concerned that the overall message could be that we should be doing ECGs and echocardiograms for every retired athlete over the age of 50, which will have a positive impact; in reality, there is potential for harm with a high rate of false positives. What we should be doing is a primary prevention discussion — discussion regarding lifestyle changes with management of CVD risk factors with a reminder that even retired athletes are at risk for CVD and their status does not render them bulletproof in terms of CVD risk.
Collapse
Amponsah M, et al. Clinical and investigative horizons. Presented at: American College of Cardiology Scientific Session; April 6-8, 2024; Atlanta.
Click Here to Manage Email Alerts