TY - JOUR
T1 - Arrhythmias and Adaptations of the Cardiac Conduction System in Former National Football League Players
AU - Aagaard, Philip
AU - Sharma, Shishir
AU - McNamara, David A.
AU - Joshi, Parag
AU - Ayers, Colby R.
AU - de Lemos, James A.
AU - Lincoln, Andrew E.
AU - Baranowski, Bryan
AU - Mandsager, Kyle
AU - Hill, Elizabeth
AU - Castle, Lon
AU - Gentry, James
AU - Lang, Richard
AU - Dunn, Reginald E.
AU - Alexander, Kezia
AU - Tucker, Andrew M.
AU - Phelan, Dermot
N1 - Funding Information:
This work supported in part by grant UL1TR001105 from the National Center for Advancing Translational Sciences, National Institutes of Health, and in part by the National Football League in association with the NFL Players Care Foundation Healthy Body and Mind Screening Program. The Dallas Heart Study was supported by a grant from the Reynolds Foundation and grant UL1TR001105 from the National Center for Advancing Translational Sciences of the National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Center for Translational Medicine, The University of Texas Southwestern Medical Center and its affiliated academic and healthcare centers, the National Center for Advancing Translational Sciences, or the National Institutes of Health.
Funding Information:
This work supported in part by grant UL1TR001105 from the National Center for Advancing Translational Sciences, National Institutes of Health, and in part by the National Football League in association with the NFL Players Care Foundation Healthy Body and Mind Screening Program. The Dallas Heart Study was supported by a grant from the Reynolds Foundation and grant UL1TR001105 from the National Center for Advancing Translational Sciences of the National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Center for Translational Medicine, The University of Texas Southwestern Medical Center and its affiliated academic and healthcare centers, the National Center for Advancing Translational Sciences, or the National Institutes of Health. AF was present in 28 individuals (NFL group: n=23, 5%; DHS group: n=5, 0.5%). In the NFL group, AF was a previously known diagnosis in 8 (35%) and previously unknown in 15/23 (65%). All former NFL with previously unknown AF were asymptomatic from an AF perspective. All individuals in the DHS group had previously known AF. In univariable regression analysis, former NFL player status was associated with 9.7 (95% CI: 3.7?25.6, P<0.001) times higher odds of AF. Stepwise multivariable regression analysis controlling for age, hypertension, diabetes mellitus, BMI, and race showed that former NFL players had 5.7 times higher odds of AF (adjusted odds ratio 5.7, 95% CI: 2.1?15.9, P<0.001) (Table). Hypertension and diabetes mellitus did not reach statistical significance in the stepwise selection model.
Funding Information:
Dr McNamara is supported by the National Heart, Lung, and Blood Institute (T32‐HL125247). The remaining authors have no disclosures to report.
Publisher Copyright:
© 2019 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
PY - 2019/8/6
Y1 - 2019/8/6
N2 - Background: Habitual high-intensity endurance exercise is associated with increased atrial fibrillation (AF) risk and impaired cardiac conduction. It is unknown whether these observations extend to prior strength-type sports exposure. The primary aim of this study was to compare AF prevalence in former National Football League (NFL) athletes to population-based controls. The secondary aim was to characterize other conduction system parameters. Methods and Results: This cross-sectional study compared former NFL athletes (n=460, age 56±12 years, black 47%) with population-based controls of similar age and racial composition from the cardiovascular cohort Dallas Heart Study-2 (n=925, age 54±9 years, black 53%). AF was present in 28 individuals (n=23 [5%] in the NFL group; n=5 [0.5%] in the control group). After controlling for other cardiovascular risk factors in multivariable regression analysis, former NFL participation remained associated with a 5.7 (95% CI: 2.1–15.9, P<0.001) higher odds ratio of AF. Older age, higher body mass index, and nonblack race were also independently associated with higher odds ratio of AF, while hypertension and diabetes mellitus were not. AF was previously undiagnosed in 15/23 of the former NFL players. Previously undiagnosed NFL players were rate controlled and asymptomatic, but 80% had a CHA2DS2-VASc score ≥1. Former NFL players also had an 8-fold higher prevalence of paced cardiac rhythms (2.0% versus 0.25%, P<0.01), compared with controls. Furthermore, former athletes had lower resting heart rates (62±11 versus 66±11 beats per minute, P<0.001), and a higher prevalence of first-degree atrioventricular block (18% versus 9%, P<0.001). Conclusions: Former NFL participation was associated with an increased AF prevalence and slowed cardiac conduction when compared with a population-based control group. Former NFL athletes who screened positive for AF were generally rate controlled and asymptomatic, but 80% should have been considered for anticoagulation based on their stroke risk.
AB - Background: Habitual high-intensity endurance exercise is associated with increased atrial fibrillation (AF) risk and impaired cardiac conduction. It is unknown whether these observations extend to prior strength-type sports exposure. The primary aim of this study was to compare AF prevalence in former National Football League (NFL) athletes to population-based controls. The secondary aim was to characterize other conduction system parameters. Methods and Results: This cross-sectional study compared former NFL athletes (n=460, age 56±12 years, black 47%) with population-based controls of similar age and racial composition from the cardiovascular cohort Dallas Heart Study-2 (n=925, age 54±9 years, black 53%). AF was present in 28 individuals (n=23 [5%] in the NFL group; n=5 [0.5%] in the control group). After controlling for other cardiovascular risk factors in multivariable regression analysis, former NFL participation remained associated with a 5.7 (95% CI: 2.1–15.9, P<0.001) higher odds ratio of AF. Older age, higher body mass index, and nonblack race were also independently associated with higher odds ratio of AF, while hypertension and diabetes mellitus were not. AF was previously undiagnosed in 15/23 of the former NFL players. Previously undiagnosed NFL players were rate controlled and asymptomatic, but 80% had a CHA2DS2-VASc score ≥1. Former NFL players also had an 8-fold higher prevalence of paced cardiac rhythms (2.0% versus 0.25%, P<0.01), compared with controls. Furthermore, former athletes had lower resting heart rates (62±11 versus 66±11 beats per minute, P<0.001), and a higher prevalence of first-degree atrioventricular block (18% versus 9%, P<0.001). Conclusions: Former NFL participation was associated with an increased AF prevalence and slowed cardiac conduction when compared with a population-based control group. Former NFL athletes who screened positive for AF were generally rate controlled and asymptomatic, but 80% should have been considered for anticoagulation based on their stroke risk.
KW - National Football League
KW - athlete's heart
KW - atrial fibrillation
KW - conduction disease
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U2 - 10.1161/JAHA.118.010401
DO - 10.1161/JAHA.118.010401
M3 - Article
C2 - 31337251
AN - SCOPUS:85070472793
SN - 2047-9980
VL - 8
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 15
M1 - e010401
ER -