A substantial gap was found between the self-reports of cardiovascular disease (CVD) by former players in the National Football League (NFL) and a "surprisingly high" prevalence of hypertension, with a "significant discrepancy between participants' awareness and observed disease prevalence," according to the findings of the HUDDLE trial, presented during the Clinical and Investigative Horizons session at ACC.24 and simultaneously published in JACC.

Between August 2021 and August 2022, the HUDDLE trial held nine screening events across the U.S., to examine the prevalence of cardiovascular disease and associated risk factors in an understudied population, often considered healthy because they are athletes, and quantify the knowledge gap as well as engage in education and identify opportunities for screening. A total of 285 former NFL players (≥50 years old, average age 63.1 years, 67.6% Black, 26.4% White, 3.6% Hispanic/Latinx) participated, a representative population of the NFL. Participants reported their health history before the screening event, and then at the event there was a health history collection, noninvasive cardiovascular screening (blood pressure [BP] measurement, 12-lead electrocardiogram [EKG] and transthoracic echocardiogram [TTE]), and education. Researchers followed up by phone 30 days later.

Results showed that only 37.5% of the former NFL players reported a history of hypertension – while 89.8% of participants were estimated to have high BP; at the screening 83.8% of participants had a BP ≥130/80 mm Hg. High cholesterol was self-reported by 32.6%, coronary artery disease by 6.3% and history of heart failure by 2.1%, and 169 former players (59.3%) reported taking cardiovascular medications. Abnormal EKGs, defined as presence of one or more prognostic finding, were observed in 46.1% of former players.

Additionally, 61.8% of participants had structural cardiac abnormalities on TTE. The presence of one or more structural abnormality was higher among participants who reported a known history of and taking medication for cardiovascular disease and an abnormal EKG at screening. Furthermore, authors Alexis K. Okoh, MD, et al., noted there was a strong association between elevated BP and structural abnormalities: 93.6% of participants with elevated left ventricular mass index had elevated BP. Multivariable analysis revealed an independent association between being hypertensive at screening and structural cardiac abnormalities on TTE (odds ratio, 2.02; p=0.04).

During the 30-day follow-up call, investigators recommended that 76.7% of participants seek additional consultation, mostly for elevated BP and abnormal TTE. Of participants who had initially reported no known history of cardiovascular disease, 65.6% were recommended for further follow-up.

"Early TTE screening may offer a significant benefit for this over 50 population by assessing for structural pathologies, facilitating timely referrals, and mitigating the consequences of undiagnosed cardiovascular disease," wrote the investigators. They also noted that the discrepancy "in awareness and prevalence of hypertension presents an opportunity for impactful population-based health intervention."