While exceptional athletes are frequently in peak physical form, they are not immune to and may even be at a higher risk of developing potentially fatal heart diseases later in life. In a study presented at the American College of Cardiology’s 68th Annual Scientific Session, former National Football League (NFL) players, particularly those with greater body proportions, were found to have heart defects specifically associated with high blood pressure.
The research is the first to look at how an athlete’s body type and training technique (strength vs. endurance) affect changes in the structure of the heart over time. It’s also the first to distinguish between changes that occur as a result of the rigorous nature of sports training, which are generally safe, and changes that occur as a result of uncontrolled high blood pressure, which could be a symptom of cardiovascular problems.
“Because of their years of athletic training at the most elite level, there tends to be an expectation that former professional players would have fewer cardiovascular issues, but there’s a growing body of research that suggests that’s not the case,” said Genevieve Smith, Ph.D., a faculty instructor at Tulane University School of Medicine and the study’s lead author.
“Our study suggests we need to be vigilant in monitoring players’ cardiovascular health because we don’t yet truly understand the long-term consequences of high-performance athletics.”
Elite athletes frequently have changes in the form and size of their hearts as a result of their extensive sports training; these modifications are referred to as “athlete’s heart.” Left ventricular hypertrophy (LVH), an increase in the thickness of the left ventricle’s wall, is one component of an athlete’s heart.
When LVH develops as a result of sports training, it is not regarded to be hazardous. LVH, on the other hand, can develop in the general population as a result of uncontrolled high blood pressure, or hypertension, and is connected to an increased risk of heart disease.
Because of their years of athletic training at the most elite level, there tends to be an expectation that former professional players would have fewer cardiovascular issues, but there’s a growing body of research that suggests that’s not the case. Our study suggests we need to be vigilant in monitoring players’ cardiovascular health because we don’t yet truly understand the long-term consequences of high-performance athletics.Genevieve Smith
The new study is part of the NFL Player Care Foundation’s continuous examination of the health of professional football players. In a study of 1,172 former players, researchers looked at echocardiograms and cardiac pictures, as well as blood pressure readings and demographic data.
Overall, roughly 12% of the players in the sample had LVH, which is equivalent to the overall population. Hypertension, a major risk factor for cardiovascular disease, appears to be associated with the disorder.
Former players with severe LVH had significantly higher blood pressure than those without LVH, by roughly 13 mm HG on average. Former players with hypertension were 1.5 times more likely than non-hypertensive athletes to suffer LVH.
The prevalence of LVH did not differ between males who had recently resigned from the NFL and those who had been retired for 20 years or more, according to the study. This shows that either LVH does not regress after retirement or that LVH recurs rather quickly after retirement from the NFL, presumably as a result of long-term uncontrolled hypertension, Smith said.
“In spite of the fact that these guys were, at one point, incredibly active and in incredibly good cardiovascular shape, down the line they may still end up having some significant cardiovascular abnormalities,” Smith said.
“What we don’t know is whether the changes we’re seeing later in life are related to the high blood pressure or to the ‘athlete’s heart’ that they had when they were professional players.”
The type of LVH, Smith and her colleagues believe, provides some indicators. The left ventricle wall is thicker and larger in concentric LVH, but the chamber (where blood accumulates during the heartbeat’s filling cycle) is normal.
Both the left ventricle wall and the chamber are expanded in eccentric LVH. Younger players are more likely to have eccentric LVH as a result of their training, while elderly players are more likely to have concentric LVH due to uncontrolled hypertension, according to Smith.
Furthermore, the researchers discovered that the likelihood of LVH was closely linked to the player’s position. LVH was most common in lineman, fullbacks, running backs, linebackers, quarterbacks, and tight ends, positions that stress strength-based conditioning and huge body size. Players in skill and speed-based positions like cornerbacks, safeties, wide receivers, returners, kickers, and punters were the least affected.
Those who worked in roles that emphasized strength-based training were equally likely to have eccentric or concentric LVH, but those who worked in skill-based positions were more likely to have concentric LVH. According to Smith, the findings highlight the importance of former players and their doctors keeping an eye on any cardiovascular risk factors and working to keep blood pressure in a safe range.
Sleep Disorder Screening Can Help Flag Players at High Risk
Obstructive sleep apnea, a common sleep issue, is another early warning indication for cardiac problems. Smith and her colleagues discovered in a separate study that a simple eight-question questionnaire provided during a check-up is a promising low-cost way to detect possible sleep apnea among former NFL players. Sleep apnea is becoming more and more associated with cardiovascular disease.
Former players who answered yes to sleep apnea symptoms on the questionnaire were more likely to have hypertension and LVH than those who said no to minimal sleep apnea symptoms.
While an overnight sleep test is required to definitively diagnose sleep apnea, Smith claims that the questionnaire can be used as a screening tool to identify patients who should be examined.
Both studies were funded by the NFL Player Care Foundation.
Smith will present the study, “The Effect of Career Playing Position and Detraining Time on the Prevalence and Persistence of Left Ventricular Hypertrophy in a Population of Former Professional Football Players,” on Saturday, March 16, 20196.
Simpson will present the study, “The Association of Obstructive Sleep Apnea with Left Ventricular Hypertrophy and Aortic Root Dilation in a Population of Former Professional Football Players,” on Monday, March 18, 2019.