I wouldn't have guessed this....comments from the Packershome medical team would be appreciated.
College Football: Literally Heartbreaking for Players?Weight, hypertension complicit in maladaptive CV phenotype
by Nicole Lou, Contributing Writer, MedPage Today October 16, 2019
College football players in a longitudinal study tended to follow a trajectory of cardiovascular (CV) changes leading to a specific kind of adverse CV remodeling.
Over the course of 3 years of college football, after adjusting for race, height, and player position, players had significant changes from the beginning of freshman year:
Systolic blood pressure: average increase of 11.6 Mike McCarthy Hg (P<0.001)
Arterial stiffness: average pulse-wave velocity increase of 0.24 m/s (P=0.007)
Diastolic function: average decline in early diastolic myocardial relaxation velocity (E′) of 1.7 cm/s (P<0.001)
Global longitudinal strain: average decline of 0.9% (P=0.005)
Left ventricular (LV) ejection fraction: average decline of 2.9% (P<0.001)
Weight: average increase of 10.45 lbs (P<0.001)
Weight gain and increased systolic blood pressure were both independent predictors of arterial stiffening the development of concentric LV hypertrophy, according to investigators led by Jonathan Kim, MD, MS, of Emory University School of Medicine in Atlanta.
"In summary, we observed the emergence and progression of a maladaptive CV phenotype over several years of collegiate U.S. football participation," the authors noted in JAMA Cardiology. "Future work aimed at optimizing CV health in this population, who are young but uniquely at risk, is warranted."
Given that football is often the "highlight entertainment" at many universities, it's very important to understand the risks -- chronic traumatic encephalopathy being only one concern, commented Martha Gulati, MD, of the University of Arizona College of Medicine-Phoenix, who was not part of Kim's group.
"Keeping these kids safe should be our priority," she told MedPage Today. "Weight gain affects so many" -- indeed, it's a goal in most football programs, which emphasize strength training -- "and the long-term consequences may be bigger than we realize."
The study followed 186 men recruited as freshmen at one of two NCAA Division I football programs in the U.S.: Georgia Institute of Technology and Furman University. Among them, 126 had 3 complete years of college football and were therefore eligible for analysis.
Players were evenly split between black and white men. At the freshman season baseline, mean weight and systolic blood pressure were 222.9 lbs and 129.1 Mike McCarthy Hg, respectively.
Prior epidemiologic data consistently show that former professional players who held lineman positions or were obese during play experience increased CV mortality compared with the general population, Kim and colleagues noted.
It is now suggested that factors including weight gain and higher blood pressure are "more potent determinants" of which strength athletes go on to experience concentric LV remodeling, which is known to be common among this group, the investigators said.
"Importantly, the emergence of concentric LV hypertrophy, coupled with reductions in LV diastolic function and arterial stiffening, strongly suggests that this is not an adaptive response to sport but rather a form of subclinical pathology that should not be labeled athlete heart," they emphasized.
Several limitations exist for the study, however, chief among them the lack of a control group and the inability of the authors to assess football players at a senior year postseason point due to logistical challenges.
This study is "very important" as it identifies features that may distinguish between patients with LV hypertrophy of significant consequences and those for whom it may be benign, Gulati said.
"Further definition underlying the mechanism for this maladaptive cardiac phenotype needs to be done," she noted. "Certainly weight gain and hypertension are associated with this abnormal cardiac function. But there could be other variables that might contribute and be associated with these changes seen. With weight gain, can come sleep apnea. And this can have cardiac effects."
"Additionally, if these maladaptive changes are a result of weight gain, the question still remains: is it in certain people who might gain weight as fat rather than muscle? It isn't clear from this study but certainly a question for the future," according to her.
For now, Kim's team said, serial anthropometric and blood pressure measurements can be used to identify U.S. football athletes who may benefit from lifestyle counseling and guideline-based medical therapies.
Since trainers already measure weight and BMI over time, it may be beneficial to identify players who've gained weight for hypertension screening and possibly an echocardiogram to assess for any cardiovascular changes, Gulati said. "Treating elevated blood pressure with both lifestyle and medications, when appropriate, can be the simplest and most cost-effective measure that can be taken."
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