Just before the Super Bowl, a study came out suggesting that career football players in the National Football League were not at increased risk of death because of their profession per se, and that their biggest killer was in fact cardiometabolic disease. Here’s how a few cardiologists reacted to the study.
“It’s important to emphasize that the overall event rate was relatively low, but regardless of this fact the most common reason for death was from cardiometabolic disease,” said James Januzzi, MD, of Massachusetts General Hospital in Boston. “This is hardly surprising, given the frequent build of NFL players, and the vulnerable populations that often play football (who often come with predisposition to diseases such as diabetes and hypertension).”
“Though there has been substantial attention given to risks associated with head trauma relative to the development of CTE [chronic traumatic encephalopathy] — a diagnosis we have yet to develop strategies to treat — it’s necessary to point out that the cardiometabolic issues that develop later in life in many NFL retirees may be entirely preventable through aggressive care of sugar, lipids, blood pressure, and weight,” said Januzzi, who also serves as cardiology consultant to the Boston Red Sox baseball team. “Thus, it is even more troubling to see these figures.”
Martha Gulati, MD, MS, of University of Arizona-Phoenix, noted that heart disease remains the number one killer of men (and women) “and even NFL players — this is not surprising and [is] expected. If the cause of death can be relied on, it seems consistent with what we know for both those regularly in the NFL and the NFL replacement players.”
Gulati pointed out that the study, which compared NFL professional and replacement players, did not provide adequate information on other cardiac events besides death or baseline risk factors. Even body mass index only pulled from initial stats when players started with the NFL.
“The comparison groups makes it impossible to really say if playing for the NFL for years is good or bad for you, since there are no differences in the two groups,” said Peter Block, MD, of Emory University in Atlanta. “But there are serious confounders, and the numbers are small, making the study underpowered for many outcomes.”
Added Gulati: “Yes, we do have to worry about CTE in the NFL and other sports with risk for brain injury, but heart disease is the leading killer, and yet more than 80% of heart disease is preventable. But it doesn’t get the same attention, not just in athletes, but overall. Additionally, much of the U.S. population watches football. Athletes are role models, long after the game is over. They can be the role models of heart health too.
“This should inform NFL players that heart disease is the most common cause of death in their community and they need to be screen for this throughout their lifetime. Much of heart disease is preventable if you treat risk factors.”
Deepak Bhatt, MD, MPH, of Brigham and Women’s Hospital in Boston, said: “In particular, younger players should be targeted for aggressive cardiovascular prevention efforts. While these results apply directly to the NFL players studied, the lessons also likely apply to weekend warriors, who would benefit from thinking more about controlling cardiometabolic risk factors.”
“The lessons we see here are the same for anyone, whether an NFL player or not,” Januzzi added. “It reiterates how common metabolic diseases such as diabetes — which predisposes to and complicates heart disease — really are. Indeed, obesity and diabetes are approaching epidemic proportion in the United States; this has led to a leveling off of the previously dropping rates of incident heart disease, with an expected upturn in rates of heart attack. It’s greatly concerning.
“For those playing football, it is a reminder there is life after the game, and attention to one’s health should not change whether in the game or after it,” he said. “Careful attention to weight, sugars, blood pressure, lipids, and other cardiac risk factors are critical. There’s no reason to wait until later in life.”