Linemen more than twice as likely as other players to have metabolic syndrome

After retirement, National Football League (NFL) linemen - generally the heaviest players - are more than twice as likely as other players to have a syndrome that puts them at risk for heart disease, stroke and other cardiovascular diseases, suggests research being presented at the 19th Annual International Symposium on Endovascular Therapy (ISET).

More than half of all retired NFL linemen have metabolic syndrome, in which a person has three or more of the following conditions: abdominal obesity, high blood pressure, high blood sugar, high triglycerides (blood fats) and low HDL (good) cholesterol.

"Large body size is a major risk factor for cardiovascular disease, and football players -- particularly linemen -- are getting bigger and bigger," said Arthur "Archie" Roberts, M.D., who will present data that was gathered by the Living Heart Foundation (LHF), which he founded. A former professional football player and retired heart surgeon, Dr. Roberts started the foundation to publicize the importance of cardiovascular health. "When I played football in the 1960s, the average lineman weighed 260 to 270 pounds. Now linemen often weigh more than 300 pounds, and many weigh 350."

Another 60 retired NFL players -- most of whom have come to attend Super Bowl XLI -- will be tested Thursday and Friday at Baptist Cardiac & Vascular Institute in Miami, and at the offices of the South Beach Preventive Cardiology Group in Miami Beach. Data collected will be added to that from the more than 900 total retired NFL players that Dr. Roberts' team has screened to date. The three-hour screening includes health education and more than a dozen tests, such as heart monitoring, blood pressure measurements and blood tests, to determine the retired player's risk of cardiovascular disease. New to this screening is the calcium scoring test, which uses computed tomography (CT) to look for calcium buildup inside the arteries, a sign of cardiovascular disease. Baptist Cardiac & Vascular Institute will be the first to perform this test for the Foundation. About 40 additional players will be scanned at the Institute throughout 2007.

Of the data analyzed by the Foundation on 550 players:

• More than half of retired NFL linemen (52.5 percent) have metabolic syndrome, compared to about one in five (22.2 percent) retired football players who played other positions, and the overall population (21.8 percent). Linemen also had a higher rate of diabetes, thicker heart walls and a greater rate of obesity and high blood pressure.
• Retired NFL linemen are 54 percent more likely to have enlarged hearts than non-linemen retired NFL players: 36.9 percent of linemen had enlarged hearts compared to 24.5 percent of non-linemen. In this assessment, the definition of an enlarged heart is a left ventricular mass of more than 125g/meter squared. Athletes typically have enlarged hearts due to intense conditioning, but it is thought their hearts return to normal size after their playing days are over. This new research suggests otherwise. An enlarged heart may persist and be a risk factor for cardiovascular disease.
• Obstructive sleep apnea occurs in three of four retired linemen (75 percent), half of all retired football players (50 percent), and only 7 to 10 percent of the overall population. Those who suffer from sleep apnea awaken often during the night and get less oxygen to the blood than is required. This puts them at greater risk for mental confusion, stroke, heart attack, daytime drowsiness and high blood pressure.

The Living Heart Foundation study is the first scientifically rigorous study of cardiovascular risk in retired football players. The average age of retired players studied is 52.

Dr. Roberts established the Foundation to educate people on the significance of cardiovascular disease, to perform screenings and to develop lifestyle programs to combat the disease. He was a practice and backup quarterback in the NFL for three years from 1965 to 1967, including two years with the Cleveland Browns and one year with the Miami Dolphins, while attending medical school.

In addition to their large body size, linemen face other challenges that put them at increased risk of cardiovascular disease. Often injured, they develop arthritis and persistent joint problems, which make exercise increasingly challenging, if not impossible. As they age, football players can't exercise easily because their old injuries bother them more, said Dr. Roberts. They're also used to eating large amounts of food, a habit that is difficult to break after they retire, he said.

Dr. Roberts has learned that weight management following football is very important; players who were large and lost weight tended to do better, from a health perspective, than those who were not so large while playing but then put on weight.

"Highlighting that some football players are at higher risk for cardiovascular disease is a great way to bring attention to an important health topic," said Barry Katzen, M.D., founder and medical director of Baptist Cardiac & Vascular Institute. "And football players aren't unique. Cardiovascular disease is the country's number one killer, and some 50 million Americans have metabolic syndrome, which increases their risk of heart disease. Anyone who has health issues such as excess abdominal fat and high blood pressure needs to be aware that they are at risk for heart disease and should consult a doctor about lifestyle changes and treatments, many of which are minimally invasive."

Considered the premier meeting on endovascular therapy, ISET is attended by more than 1,200 physicians, scientists and industry professionals from around the world. The meeting pioneered the use of live cases to promote the multidisciplinary treatment of vascular disease. ISET is presented by the Baptist Cardiac & Vascular Institute, Miami.

The Living Heart Foundation (Little Silver, N.J) is a nonprofit organization established in 2001 to combat cardiovascular disease and provide risk stratification for cardiac, pulmonary, and metabolic conditions through on-site screening and integrated health programs.