HUDDLE: Cross-sectional study finds large gap between hypertension prevalence and awareness among former NFL athletes

By Lucas Marinacci on

Key Points:

  • Little is known about the prevalence of cardiovascular risk factors or disease in former professional athletes.  Gaps may exist between the awareness and prevalence of CVD in this population. 
  • This cross-sectional study of National Football League (NFL) alumni who participated in cardiovascular screening events found that 90% had HTN, 46% had an abnormal EKG, and 62% had structural abnormalities on TTE.  Overall, 84% were found to have an elevated BP but only 38% had a self-reported a history of HTN. 
  • There may be a significant knowledge gap between self-awareness of CVD and actual CVD prevalence among retired NFL athletes.

Estimates of cardiovascular risk factors and disease (CVD) prevalence among retired elite athletes are lacking.  They are a special population, as they may be less likely to be screened or seek screening because of perceived healthy lifestyle habits, even though they may be at significant risk for CVD.

On April 7, 2024, the principal results of the “Prevalence of Cardiovascular Disease and Risk Factors among NFL Alumni and their Family Members: The HUDDLE Study” were presented at ACC Scientific Sessions 2024 with simultaneous publication in The Journal of the American College of Cardiology.  The purpose of this study was to assess CVD and risk factor prevalence and awareness in a sample of former NFL players, coaches, and families.

This was an observational cross-sectional study that included former NFL players or coaches and family members aged 50 or order who participated in one of eight CVD screening events, which included a health history questionnaire, cardiac testing with EKG, blood pressure (BP) measurement, and transthoracic echocardiography (TTE), as well as an interactive educational session.  Hypertension (HTN) was defined as a measured BP >130/80 in a seated, resting position, with additional readings taken during the session at the staff’s discretion and averaged if “white-coat” HTN was suspected.  Investigators prespecified the definitions of clinically relevant EKG abnormalities and used American Society of Echocardiography guidelines to define abnormal TTEs.  Test results were de-identified and analyzed at a central core lab.  At 30 days, a phone visit was held to discuss results and make follow-up recommendations. 

A total of 498 participants were included in the analysis, all of whom completed the 30 day phone visit. Of these, 285 were former NFL players and 213 were former coaches or family members.  The average age was 63 years and 63% were Black.  Nearly 90% for former players either had a history of HTN or had a measured BP above threshold, 36% had an abnormal EKG, 62% had an abnormal finding on TTE, and 1 had thoracic aneurysm identified that underwent subsequent surgical repair.  Of all participants, 80% reported no history of HTN but had a BP above threshold.

This study had multiple limitations.  Histories were self-reported with risk for recall bias, and BPs were recorded at a single encounter.  Most participants were from the southern US, limiting generalizability.  There was no comparison group or long term follow up.

Dr. Michael Amponsah of Banner Boswell Medical Center in Peoria, AZ concluded: “The surprisingly high prevalence of CVD and risk factors in this population…signifies a need to increase awareness of CVD and develop sustainable strategies to ameliorate risk.”