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Race and Concentric LV Hypertrophy in Football Athletes
Quick Takes
- American-style football athletes are at risk for the development of concentric left ventricular hypertrophy (C-LVH), a well-established cardiovascular risk factor in the general population.
- This is the first study to specifically focus on C-LVH in the context of race and a particular sport.
Study Questions:
Is Black race associated with acquired concentric left ventricular hypertrophy (C-LVH) in collegiate football players?
Methods:
American-style football (ASF) athletes from two US universities were recruited as freshmen and evaluated over 3 years. Demographics, clinical characteristics, and echocardiography were recorded at multiple time points. A mixed-modeling approach assessed acquired C-LVH in black versus white athletes controlling for playing position (linemen [LM] and non-linemen [NLM]), family income, body weight, and blood pressure.
Results:
The final cohort was comprised of 249 athletes (124 black athletes). Black athletes were more often NLM (72% vs. 54%, p = 0.005) with lower median neighborhood family income ($54,119 vs. $63,146, p = 0.006) compared to white athletes. Both black and white LM demonstrated similar increases in C-LVH over time. However, over the same time period, acquired C-LVH was significantly more common in black than white NLM. Independent of race, those with C-LVH were heavier, more hypertensive, and had relative higher arterial stiffness and reduced diastolic function. In further analysis stratified by race and player position, black race was associated with acquired C-LVH in NLM (odds ratio [OR], 3.70; 95% confidence interval [CI], 1.12-12.21; p = 0.03), and LM was associated with acquired C-LVH in white athletes (OR, 3.40; 95% CI, 1.03-11.27; p = 0.048).
Conclusions:
Among ASF players in this cohort, black race was significantly associated with acquired C-LVH in NLM; LM position was significantly associated with acquired C-LVH in white athletes.
Perspective:
Concentric LVH (C-LVH) is a well-established cardiovascular risk factor in the general population; C-LVH is a manifestation of adverse LV remodeling from pressure overload due to chronic conditions such as hypertension; recent data have shown that ASF players, especially those who play the lineman (LM) positions, are at increased risk for weight gain, hypertension, and subsequent maladaptive C-LVH.
This study builds on past findings, highlighting that LM in ASF (both black and white) are at increased risk of adverse cardiac remodeling. The authors also demonstrated that black race was, independent of family income and changes in weight and blood pressure, associated with development of C-LVH in NLM, a group expected to have less exposure to isometric exercise. Reduced diastolic function was noted in those with C-LVH. This unique study should prompt further investigation into preventive care of young athletes that accounts for the interplay between sport, race, and socioeconomics. Limitations of the study include the lack of matched control groups and potential overlap of level of isometric training between LM and NLM.
Clinical Topics: Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Noninvasive Imaging, Prevention, Sports and Exercise Cardiology, Acute Heart Failure, Echocardiography/Ultrasound, Exercise, Hypertension, Sports and Exercise and Imaging
Keywords: African Americans, Athletes, Blood Pressure, Body Weight, Echocardiography, Exercise, Football, Heart Failure, Hypertension, Hypertrophy, Left Ventricular, Secondary Prevention, Socioeconomic Factors, Vascular Stiffness, Ventricular Remodeling, Weight Gain
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