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Prevalence of CVD Risk Factors Among NFL Alumni – HUDDLE
Quick Takes
- In a cross-sectional study of 285 former NFL players ≥50 years old, hypertension (self-reported or on screening assessment of blood pressure) was present in 89.8% although only 37.5% reported a history of hypertension.
- Over one-half of participants had an abnormality on screening transthoracic echocardiography (TTE), and hypertension was independently associated with the presence of a TTE abnormality.
- The study did not assess clinical outcomes and does not reflect cardiovascular risk factor screening in a general population of people ≥50 years old.
Study Questions:
What is the prevalence and self-awareness of cardiovascular disease (CVD) and CVD risk factors among former National Football League (NFL) players?
Methods:
The HUDDLE (Heart Health: Understanding and Diagnosing Disease by Leveraging Echocardiograms) trial was an industry-sponsored, multi-city, cross-sectional study of members of the NFL Alumni Association (including former players and coaches, and extended family members) ≥50 years old in which participants self-reported their personal health history and were evaluated at one of nine screening events (August 2021–August 2022) with assessment of blood pressure (BP), 12-lead electrocardiogram (ECG), and transthoracic echocardiography (TTE). Exclusion criteria included chronic obstructive lung disease and body mass index (BMI) ≥50 kg/m2. Hypertension (HTN) was defined as either self-reported HTN or BP ≥130/80 mm Hg on screening. ECG abnormalities included atrial enlargement, left ventricular (LV) hypertrophy, atrial arrhythmias, atrioventricular block (AVB) including 1° AVB, fascicular or bundle branch blocks, pathological Q-waves, and T-wave inversion or nonspecific T-wave abnormalities. Structural abnormalities on TTE were based on American Society of Echocardiography guidelines.
Results:
A total of 498 participants were screened, of whom 285 (57.2%) were former NFL players. Of these 285, 192 (67.6%) were African American and 75 (26.4%) were White; the average age was 63.1 years (range 50-82 years) and BMI was 31.2 kg/m2 (range 21.0-46.7 kg/m2). The prevalence of HTN was estimated to be 89.8%, although only 37.5% reported a history of HTN. An abnormal ECG was identified in 46.1%, and a structural cardiac abnormality on TTE was present in 61.8% (most commonly including increased LV wall thickness, increased left atrial diameter, low LVEF, increased LV mass index, increased right ventricular diameter, and an LV wall motion abnormality). Multivariable analysis revealed that being hypertensive at screening was independently associated with the presence of a structural abnormality on TTE (odds ratio, 2.02; 95% confidence interval, 1.03-3.96; p = 0.04).
Conclusions:
There was a large discrepancy between participant self-awareness and the actual prevalence of CVD and risk factors. Structural cardiac abnormalities were observed in a majority of participants and were independently associated with HTN. The authors conclude that the study highlights a significant opportunity for population health interventions, and affirms the role of TTE for CVD screening in this population aged ≥50 years.
Perspective:
NFL players are known to have a high prevalence of CVD risk factors, including a high prevalence of HTN that often is accompanied by LV hypertrophy. It is therefore not surprising that this study of former NFL players found a high prevalence of HTN that was associated with structural abnormalities on TTE including markers of LV hypertrophy. The study did not address clinical outcomes, and without testing whether data from TTE had incremental clinical value, the study does not seem to support the authors’ conclusion that screening TTE has a clinically meaningful role. Of greater pertinence might be a study addressing the role of CVD screening in a general population, and assessment of whether and how screening might reduce future CVD clinical events (including testing a possible hypothesis that data from screening TTE might affect outcome).
Clinical Topics: Sports and Exercise Cardiology
Keywords: ACC24, ACC Annual Scientific Session, Cardiovascular Diseases, Social Determinants of Health
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