- Sports medicine practitioners and other clinicians should consider monitoring the cardiovascular health of football players who develop hypertension or gain significant weight at any level of participation
- College freshmen football players were more likely than high school senior players to experience reductions in LV diastolic function and develop arterial stiffening between the start and end of the season
- This pattern of cardiovascular remodeling was more common in collegiate linemen than in collegiate non-linemen
- Intra-season weight gain and increased systolic blood pressure appeared to be synergistic mechanisms of the cardiovascular remodeling
Football players at both the collegiate and professional levels are known to have an increased risk for hypertension, which has been linked to asymptomatic cardiovascular pathology. However, little is known about the cardiovascular impact of football participation at the high school level.
Aaron L. Baggish, MD, director of Mass General's Cardiovascular Performance Program, and colleagues have determined that the cardiovascular response to football participation does not appear to emerge until after the transition from high school to college. They report their findings in Medicine and Science in Sports and Exercise.
Between 2014 and 2016, the researchers prospectively enrolled 87 college freshman and 61 high school seniors at two southeast U.S. Division I colleges and three high schools in Atlanta, GA. The athletes were evaluated at two predefined time points:
- Immediately before preseason training started
- Five to six months later, at the end of the season
The primary outcome measures were left ventricular (LV) mass and LV diastolic function, both evaluated with two-dimensional echocardiography, and vascular function (arterial stiffness), measured with vascular applanation tonometry.
The researchers found that between the two evaluations:
- Only collegiate players demonstrated significant increases in body mass and systolic blood pressure
- Change in LV mass was not significantly different between collegiate and high school players, but in the post-season, collegiate players had significantly higher rates of concentric LV hypertrophy than high school players did
- LV diastolic function, LV systolic function and vascular function remained unchanged among high school players. In contrast, among collegiate players, LV diastolic function and vascular function significantly declined, and LV systolic function showed a non-significant declining trend.
- Changes in weight, systolic blood pressure, cardiac structural geometry, diastolic function and vascular function were more pronounced for collegiate linemen than for collegiate non-linemen or high school players at any position.
In multivariable analyses adjusted for age and ethnicity, body mass was an independent predictor of post-season arterial stiffness and LV diastolic function, and systolic blood pressure was an independent predictor of post-season LV mass and arterial stiffness. Intra-season weight gain and increased systolic blood pressure appear to be synergistic mechanisms of the cardiovascular remodeling, the researchers say.
They add that their findings can be used to counsel parents and high school football players who have concerns about cardiovascular health. On the other hand, trainers and clinicians should consider monitoring the cardiovascular health of football players who develop hypertension or gain significant weight at any level of participation.
Learn more about Mass General's Cardiovascular Performance Program
Refer a patient to the Mass General Heart Center