Screening for cardiovascular problems in elite-level football players should begin in high school and continue throughout the lives of college and professional players. Mayo Clinic physicians based that conclusion on the results of their new study of the cardiovascular health of 233 retired National Football League (NFL) players.
The Mayo data showed that 82 percent of NFL players under age 50 had abnormal narrowing and blockages in arteries, compared to the general population of the same age. This finding suggests that the former athletes face increased risk of experiencing high blood pressure, heart attack or stroke. The report on research conducted by the Mayo Clinic Arizona group will be presented next week at the American College of Cardiology Annual Scientific Session in Chicago.
Significance of the Mayo Clinic Study
This is the first and largest study to measure comprehensive cardiovascular performance measures on retired NFL athletes, ages 35 to 65. Its findings add to the emerging portrait of poor heart health among this group of retired athletes. The findings also suggest that players as young as high school age who are engaged in serious competitive-conference level of training and play may benefit from regular cardiovascular screening. "What we hope to emphasize with our findings is that all NFL players -- retired or not -- need to undergo cardiovascular health evaluation because they may have changes in heart and vessel conditions that we can treat so they don't experience problems later in life," says Robert Hurst, M.D., Mayo Clinic cardiologist and lead researcher.
Adds chair of cardiovascular diseases at Mayo Clinic in Arizona and researcher Bijoy Khandheria, M.D.: "Cardiovascular screening is readily available and needs to become a routine part of serious football players' health care, beginning at the high school level for those who are engaged in a highly competitive and rigorous level of training and play."
Football and Heart Problems
Previous research by various institutions and investigators in recent years showed concerning health trends:
- Retired NFL players are more prone to obesity and obstructive sleep apnea than the general population.
- Retired NFL players have an increased rate of metabolic syndrome, a condition increasingly linked to excess weight and lack of activity, which can lead to type 2 diabetes.
- Higher mortality is reported in linemen, as compared to people in the general population of the same age who are not professional football players. Research is needed to determine the causes.
Observing these serious trends, the Mayo Clinic researchers undertook the study to define vascular health and, by association, cardiovascular risk in retired NFL players. To determine vascular health, the Mayo team conducted multisite screening events with the help of players' associations. Investigators measured the internal diameter of the carotid artery. They also assessed plaque deposits which can block blood flow.
The most striking results showed that:
- In players less than 50 years old, 82 percent had either plaque or carotid narrowing greater than the 75th percentile of the population, adjusted for age, sex and race. This represents a dangerous level of narrowing that could lead to a catastrophic reduction of blood flow resulting in heart attack or stroke.
- Heart disease had not been previously diagnosed in these players. Nor had they experienced symptoms of heart disease, such as chest pain upon exertion.
- As a result, the players did not know that they were at serious risk of heart attack or stroke, or that they needed to make lifestyle changes or start medical therapy to improve the capacity of their cardiovascular systems to maintain blood flow.
The Mayo research team concluded that because test results showed evidence of asymptomatic narrowing of the arteries -- called atherosclerosis -- the retired NFL players are at abnormally high risk for an adverse cardiovascular event, as compared with people of the same age in the general population. In addition, the high incidence of plaque found in players' vessels suggests that the increased narrowing is not solely due to increased body mass index. Further research is needed to explain this. In the meantime, football players will benefit from regular cardiovascular screening. "Effective therapies are available to help players avoid serious cardiovascular problems later in life, but players need to take that first step of seeking out screening programs to identify those at risk," Dr. Khandheria says.
Collaboration and Support
Other Mayo Clinic researchers are Erik Wissner, M.D.; Robert Burke, M.D.; and Chris Kendall, all of Mayo Clinic, Scottsdale/Phoenix, Ariz. Their work was supported by Mayo Foundation for Medical Education and Research.
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