Association between race and maladaptive concentric left ventricular hypertrophy in American-style football athletes

• Authors: Arshed Quyyumi, Emory University; Herman Taylor, Emory University; Jonathan Kim, Emory University; J Tso, Emory University; CG Turner, Emory University; C Liu, Emory University; A Galante, Georgia Institute of Technology; CR Gilson, Georgia Institute of Technology; C Clark, Furman Univ; AL Baggish, Massachusetts General Hospital
• Journal Title: BRITISH JOURNAL OF SPORTS MEDICINE
• Volume: Volume 56, Number 3
• Publisher: BMJ PUBLISHING GROUP | 2021-08-13, Pages 151-+
• Type of Work: Article
• Publisher DOI: http://doi.org/10.1136/bjsports-2021-104333
• Keywords: Science & Technology; Life Sciences & Biomedicine; Sport Sciences; football; cardiology; cardiomegaly; exercise-induced; longitudinal studies; SOCIOECONOMIC-STATUS; BLOOD-PRESSURE; HEART; MASS; RECOMMENDATIONS; IMPACT; ADAPTATIONS; MORTALITY; INDEX

Abstract

OBJECTIVES: American-style football (ASF) athletes are at risk for the development of concentric left ventricular hypertrophy (C-LVH), an established cardiovascular risk factor in the general population. We sought to address whether black race is associated with acquired C-LVH in collegiate ASF athletes. METHODS: Collegiate ASF athletes from two National Collegiate Athletic Association Division-I programmes were recruited as freshmen between 2014 and 2019 and analysed over 3 years. Demographics (neighbourhood family income) and repeated clinical characteristics and echocardiography were recorded longitudinally at multiple timepoints. A mixed-modelling approach was performed to evaluate 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: At baseline, black athletes (N=124) were more often NLM (72% vs 54%, p=0.005) and had lower median neighbourhood family income ($54 119 vs $63 146, p=0.006) compared with white athletes (N=125). While both black and white LM demonstrated similar increases in C-LVH over time, among NLM acquired C-LVH was more common in black versus white athletes (postseason year-1: N=14/89 (16%) vs N=2/68 (3%); postseason year-2: N=9/50 (18%) vs N=2/32 (6%); postseason year-3: N=8/33 (24%) vs N=1/13 (8%), p=0.005 change over time). In stratified models, black race was associated with acquired C-LVH in NLM (OR: 3.70, 95% CI 1.12 to 12.21, p=0.03) and LM was associated with acquired C-LVH in white athletes (OR: 3.40, 95% CI 1.03 to 11.27, p=0.048). CONCLUSIONS: Independent of family income and changes in weight and blood pressure, black race was associated with acquired C-LVH among collegiate ASF NLM and LM was associated with acquired C-LVH in white athletes.