11th July 2012
Researchers funded by the charity Cardiac Risk in the Young (CRY) have published a review in the journal “Heart” (July 6 2012)1 that could reshape future national guidelines for the testing of elite athletes of black ethnicity.
The paper, co-authored by Dr Navin Chandra, Dr Michael Papadakis (CRY Research Fellows) and Professor Sanjay Sharma (CRY’s Consultant Cardiologist and the only cardiologist for the London 2012 Olympic Games) highlights that the differences in the physiology of the heart of black athletes could cause ‘false positive’ diagnoses of cardiac abnormalities and in some cases lead to disqualification from competitive sport.
It is widely understood that the heart can ‘change’ due to regular and intense exercise – a phenomenon that is termed as ‘athlete’s heart’. This is taken into account when athletes are screened for underlying abnormalities. However, the extent to which cardiac adaptation occurs in an athlete’s heart can also be significantly influenced by a number of factors, one of which is ethnicity.
CRY – which had just completed a week long presentation of its on-going research at the Royal Society’s prestigious Summer Science Exhibition2 – has been collating the results of specialist screenings among elite athletes since 1993, comparing the prevalence of pathological conditions such as hypertrophic cardiomyopathy (HCM) among the elite sporting community, with the general population.
However, researchers from CRY are now expanding this analysis by looking at the ‘natural’ and safe changes that can manifest in the heart of a black athlete but which ‘mimic’ the appearance of an abnormal heart muscle that might go on to cause sudden death in a Caucasian athlete.
The findings are particularly relevant in the light of the continued increase in the number of black athletes participating in competitive sports at national and international levels in both Europe and the USA, particularly in sports such as American Football and basketball. In the States, approximately 13% of the population is of black ethnicity, yet over 70% of the National Football League and National Basketball Association is comprised of black athletes3.
Similarly, in the UK, where just 2% of the general population is of black ethnicity, there is a 10-fold higher prevalence of black athletes participating regularly in the Premier League4.
Professor Sanjay Sharma, comments; “It is vital that, globally, cardiologists understand the fundamental differences between a ‘normal’ heart, an athlete’s heart and a black athlete’s heart; and that the appropriate considerations are taken on board when these individuals are being routinely screened.
“Whilst cardiac screening, such as the model we provide at CRY, is not mandatory for elite sportsmen and women, ethically an athlete might be urged to withdraw from competitive sport if a condition such as hypertrophic cardiomyopathy or a problem with the heart’s rhythm were to be identified.
“We also have the additional consideration that death rates from HCM are generally higher among black athletes than white athletes. A long terms study in the US showed that 20% of sudden deaths in black athletes were caused by HCM, compared to 10% of white athletes5 – showing that any abnormalities found cannot be ignored and have to be investigated further.
“However, the more we learn about the different ways that the size and appearance of the heart can change (based on factors such as age, gender and ethnicity) then the more we will be able to ensure that we are making clinical decisions on an individual basis and assessing the risk of a cardiac abnormality within a safe and personalised framework.”
Every week in the UK, 12 seemingly fit and healthy young people under the age of 35 die from sudden cardiac death. Many – although not all – of these young people were involved in sport. Sport itself does not cause this problem but can exacerbate an existing undiagnosed condition. 80% of those that die have no symptoms, so the only way to identify a problem is through screening.
In Italy, athletes undergo a unique mandatory state-sponsored cardiovascular screening programme that incorporates clinical history, physical examination and a 12-lead ECG. Data from this 30 year model has shown a significant increase in identification of HCM and death rates from sudden cardiac death has fallen by 90%.
The Italian pre-participation model has now been endorsed by leading sporting organisations including the European Society of Cardiology and the International Olympic Committee. However, the CRY researchers who authored this latest review have raised concerns that the recommendations from this well established model are based on an ethnically homogenous population of white athletes – not taking into account cardiac adaptations on athletes of black ethnicity.
Professor Sharma adds; “Whilst we are rightly focused on identifying and treating athletes – as well as young people at grass roots level – we cannot underestimate the impact of giving a professional athlete at the start of a promising a career, a false positive result. At the very least, this causes undue anxiety for them and their family – but ultimately may also have a serious financial and social effects, as well as a lifetime of unnecessary screening and insurance implications for their family.”
CRY provides screening services for a number of professional sporting bodies including the English Institute of Sport, the RFU, RFL, LTA, a number of FA teams including Manchester City, and the vast majority of the Olympic Athletes (GB Rowing, GB Cycling, GB Swimming, GB Diving, UK Athletics).
Dr Steve Cox, CRY’s Director of Screening, comments; “Our acclaimed screening programme – which was first launched in 1995 – is now part of a wider research programme that is building our understanding of the incidence of cardiac conditions in young people and informing national policy on best practice to minimise the incidence and impact of young sudden death.”
Leading black athlete and GB Olympic hopeful, Lawrence Okoye – who holds the British discus record and the record for the longest discus throw in history by a teenager – is also helping CRY to promote the importance of cardiac screening by taking part in a new series of short films.
Lawrence – who is a now a Patron of the charity – is featured in four new films that can be viewed on CRY’s YouTube channel or at www.c-r-y.org.uk/royalsociety.htm. The films follow his ‘journey’ through the cardiac screening process (ending with him being given the all clear!).
ENDS
For more information about the published review in “Heart” or to request an interview with Professor Sanjay Sharma or Dr Steve Cox, please call Jo Hudson in the CRY Press Office on 020 8786 3860 / 0770 948 7959: jo.hudson@trinitypr/co.uk
References:
1 Heart (2012). Doi:10.1136/heartjnl-2012-301798
2 ‘The athlete’s heart: Young heart for life’: http://sse.royalsociety.org/2012/exhibits/athletes-heart
3 Lapchick R, Matthews K. 1998, Racial and Gender Reoirt Card, Boston, MA: The centre for the study of sport in society, 1999
4 Preston I, Szymanski. Racial discrimination in English football. Scott J Polit Econ 2000: 47:342-63
5 US National Registry of Sudden Death in Athletes (1980 – 2006)
Notes to editors:
CRY was founded in May 1995. As well as campaigning and lobbying and the provision of its subsidised cardiac screening programme for young people (35 and under), the charity also provides counselling support to bereaved families and young individuals who may be diagnosed.
CRY’s Consultant Cardiologist, Prof Sanjay Sharma, is the leading Sports Cardiologist in the UK, and recognised as one of the leading experts for Young Sudden Cardiac Death worldwide. He makes no charge for supervising the CRY screening programme. With Professor Sharma’s support CRY is able to subsidise the programme so that each appointment only costs £35. Privately this test could cost in excess of £100, just for the ECG and consultation.
Sudden Cardiac Death (SCD) is an umbrella term for a number of different heart conditions that affect fit and healthy people which, if not treated can result in a dramatic and or / spontaneous death. In about one in 20 cases of sudden cardiac death, no recognised cause can be found – even after post-mortem. This is then called Sudden Arrhythmic Death Syndrome (SADS). Many experts are now claiming that the actual number of deaths recorded could just be ‘the tip of the iceberg’ with many causes being wrongly recorded as asthma, epilepsy or even drowning.
