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Comparison of National Football League Linemen Versus Nonlinemen of Left Ventricular Mass and Left Atrial Size

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Retired National Football League (NFL) linemen have higher cardiovascular mortality compared with nonlinemen. We examined echocardiographic characteristics of retired NFL linemen compared with nonlinemen to determine if position-dependent cardiac remodeling resulted in increased left ventricular (LV) mass and left atrial (LA) size. We performed echocardiography in 487 retired NFL football players. Demographic, medical, and professional career information was collected. Interventricular septal and posterior wall thickness, LV end diastolic diameter, and LA area were measured. Body mass index (BMI) and LV mass were calculated. Retired linemen had significantly higher LV mass (234.8 ± 65.8 g) than nonlinemen (199.8 ± 55.4 g, p <0.0001). LA area was higher in linemen versus nonlinemen (22.5 vs 20.1 cm2, p <0.0001). Independent predictors of increased LV mass were BMI (p <0.003), linemen position (p <0.024), and systolic blood pressure (p <0.005). In former players with BMI <35 kg/m2 there was a difference between linemen and nonlinemen in LV mass (219.9 ± 44.3 vs 182.6 ± 44.3 g, p = 0.004) and LV mass/height (114.3 ± 23.5 vs 98.8 ± 25.2 g/m, p = 0.005). In former players with BMI >35 kg/m2, there was no difference. There was no difference in LA area between linemen and nonlinemen in both BMI groups. In conclusion, LV mass and LA area size were highest in retired linemen. Player BMI, position, and systolic blood pressure were significant predictors of LV mass. In retired linemen compared with retired nonlinemen, the persistence of these cardiac adaptations may contribute to the higher cardiovascular mortality seen in retired linemen.

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Methods

The Living Heart Foundation, an Institutional Review Board-approved nonprofit organization, conducted an open multicity health screening for retired NFL players between August 2003 and June 2006. Retired NFL players were mailed a letter, signed by a representative of the NFL Players Association, inviting them to a no-fee health screening in their area; 574 participants self-reported demographic, ethnicity, medical, and professional career information. Retired players who played tackle, guard,

Results

Demographic, medical, and professional career information is listed in Table 1; 574 participants were screened, 32% were retired linemen, and 68% were nonlinemen. Of the 574 former players, 487 players (85%) underwent complete echocardiograms during screening and were included in this study. There was no significant difference between linemen and nonlinemen in age, years played in the NFL, and years since retirement. There was a significant difference between the retired linemen and nonlinemen

Discussion

Our study is the first to examine cardiac morphology in retired NFL players. A previous echocardiographic report of elite college football players demonstrated increased LV mass compared with controls.3 Whether cardiac morphological changes that occur during the career of professional football players persist into retirement is unknown. We found that retired linemen had higher LV mass and larger left atria than retired nonlinemen long after deconditioning. We also found that retired linemen had

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Adam Belanger received funding from The Doris Duke Clinical Research Foundation.

Dr. Roberts received funding from Phillips, Siemens, Pfizer, General Electric, ResMed, and the Professional Athletes Trust Fund.

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