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Investigators said all players should have their blood pressure checked and if their blood pressure is high they should undergo an ultrasound to check for possible structural damage.

ATLANTA, Ga.—Retired professional football players are at risk for their cardiovascular health, a new study suggests.

Among a group of athletes who retired from the National Football League (NFL), nearly 90% had high blood pressure, and the majority were unaware they had it, a study said last week at the American College of Cardiology’s 2024 Scientific Sessions. reported. Structural cardiac abnormalities detected by transthoracic echocardiography (TTE) were also highly prevalent.

Alexis K. Okoh, MD, PhD, of Emory University in Atlanta, Georgia, who led the HUDDLE study, said the discovery was a “huge shock” for researchers.

“It’s scary when nine out of 10 people are completely asymptomatic and randomly walk into a room and find out they have high blood pressure,” he told TCTMD. “About 37% of them are reported to have a history of high blood pressure, and there is a huge knowledge gap. 5-6 in 10 people did not know they had this problem. ”

Structural abnormalities in the TTE also suggest that these retired NFL players have suffered some end-organ damage as a result of high blood pressure, he added.

Michael Amponsah, M.D. (Banner Boswell Medical Center, Sun City, Ariz.), who announced the HUDDLE results this week, said that early screening for cardiovascular risk relies primarily on risk scores, but “particularly “If we are dealing with specific symptoms, we may not be able to provide a complete picture.” a particular special group. ” Professional athletes are “perceived” to be in the best of health, but this may no longer be the case as they age.

“They are very physically active, at least during their formative years,” Amponsah told TCTMD. “The assumption is that it will continue after they retire. It is also assumed that these will be made of Teflon. We think of them as gladiators running through the fields, We think it’s a symbol of health. We decided to find out what it meant, and the results were quite surprising.”

We think of them as gladiators running through the fields, and we think of them as symbols of good health. Michael Amponsah

past research Professional American football players have a higher prevalence of sleep apnea and prehypertension/hypertension, and linemen and players with a body mass index (BMI) of 30 or higher during their playing days have higher rates of cardiovascular mortality and cardiometabolic syndrome. have been shown to be at high risk. More recent studies have been conducted in college football players, which again show a high prevalence of prehypertension/hypertension.

highly prevalent structural changes;

“HUDDLE” was published at the same time as “HUDDLE”. Journal of the American College of Cardiologywas designed to assess the prevalence of cardiovascular disease and risk factors in a representative sample of retired NFL players (age 50 and older), their families, and coaches. Nine screening events were held across the United States from 2021 to 2022, and participants had blood pressure measurements, as well as 12-lead electrocardiograms and TTE measurements. A follow-up telephone visit with a physician occurred after his 30 days of screening and recommendations for further care were provided as needed.

Hypertension was defined as 130/80 mm Hg or higher according to the 2017 Clinical Guidelines for Blood Pressure Assessment. An abnormal ECG was defined as the presence of one or more prognostic findings based on the clinical expertise of the attending physician. Structural changes were defined using gender-specific cutoffs based on American Society of Echocardiography guidelines, including increased LV mass index (LVMI) and changes in valve gradient.

A total of 498 participants were tested, including 285 former NFL players (mean age 63.1 years, 67.6% African American/Black). The average BMI of these former athletes was 31.2. On screening tests, 37.5% reported high blood pressure, 32.6% high cholesterol, and 12.6% diabetes.

Overall, the prevalence of hypertension was 89.3% for the entire cohort and 89.8% for NFL players. Among NFL players known to have high blood pressure, 36.5% still had elevated blood pressure levels, and only 6.7% of former players with high blood pressure had their blood pressure under control.

Regarding electrocardiography, 37.5% had abnormal findings. Among NFL players, almost half (46.1%) had abnormal prognostic findings. In TTE, his 55.0% of the entire cohort and his 61.8% of retired players had structural changes considered abnormal by ASE guidelines. According to the researchers, there was a strong association between elevated systolic blood pressure and structural abnormalities. For example, 93.6% of players with elevated LVMI had elevated blood pressure. This measurement is an important prognostic predictor of mortality, adjusted for patient size, Okoh said. Additionally, his known history of CVD, use of CVD medications, and abnormal his ECG were also associated with structural changes in his TTE.

As of 30 days into the study, 76.7% of former NFL players had been advised to seek additional follow-up, with hypertension or abnormal TTE findings being the most common reasons.

“Just because you’re an American football athlete doesn’t mean you’re not at risk,” Amponsah said. “Working out like this isn’t necessarily risk-free. Maybe it’s time to change the way we think and assume these gentlemen. American-style football isn’t necessarily bad. But the risks are there and they need to take good care of themselves.”

Former athletes aren’t bulletproof

Dr. Matthew Martinez, a cardiologist for the New York Jets, National Basketball Players Association, and Major League Soccer (Morristown Medical Center/Atlantic Health System, N.J.), emphasizes that this is not just a sports issue, and that He said so. The prevalence of untreated and uncontrolled hypertension is extremely high worldwide. Primary prevention is the best option for everyone, including retired professional athletes.

“Just because you’re a current or former athlete, like all of us, doesn’t make you bulletproof,” he said during an ACC panel. “Even people who used to exercise or are actively exercising can still have heart disease. Just because they’re former NFL players, they’re still not out of the woods. Adaptive changes are often overlooked because they are considered bulletproof.”

Regarding screening, he cautioned that the standard criteria for an abnormal electrocardiogram or echocardiogram is different for athletes, especially African-American men. According to Martinez, the left and right ventricles, wall thickness, and ejection fraction, including LVMI, are often “abnormal” in about 10% of active athletes, and standard cutoff values ​​can lead to false-positive diagnoses. There are concerns that this could lead to

Like all of us, just because you’re a current or former athlete doesn’t mean you’re perfect. Matthew Martinez

Okoh noted that retired athletes have been active for more than 25 years, adding that many are now just “ordinary people.” “I don’t know if it’s appropriate to apply athlete standards to them or general population standards,” he says. “That’s a question that the scientific community has to consider.”

Nevertheless, Okoh said all retired athletes should have their blood pressure tested and the results show that ECG and TTE screening also plays a role in risk stratification, especially among athletes with hypertension. He said it suggests that he is fulfilling his role. “We believe this gives us the opportunity to intervene if necessary and, most importantly, follow up very closely to reduce future cardiovascular events,” he said. Stated.

Amponsah noted that even among the small number of former athletes with normal blood pressure, the prevalence of structural abnormalities in TTE is high. “Primary prevention is everything,” he said. “It starts with blood pressure, but I think there may be a role for transthoracic echocardiograms in people over 50.”

Mr Okoh said the initial screening included an information session and physician-led panel discussion on CVD, risk factors, symptoms and prevention. He also noted that 30-day follow-up of players, families and coaches was 100%.

“When you educate people, they begin to participate effectively,” he said. “All of our participants followed up well. We’ve never done a study where we had 100% follow-up and actually told us something fairly new. Because we really want to move this forward. If so, you need to fill in the knowledge gaps so you can implement something and have a better chance of success.”

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