Heart disease in professional football and baseball athletes

A new study published in JAMA Network Open by researchers from the Harvard T.H. Chan School of Public Health showed that American football players have a higher risk of heart disease, brain disease and premature death than baseball players of the same age.

The authors chose to compare National Football League (NFL) football players with Major League Baseball (MLB) baseball players, since both groups are professional athletes in comparable physical condition but one sport involves frequent, violent contact and the other does not. Their findings are based on a retrospective analysis of death rates and causes of death in 3,419 NFL and 2,708 MLB players over more than 30 years. After adjusting for age and race, they found a 26 percent higher rate of premature death among football players compared with baseball players. The risk of dying from neuro-degenerative diseases was three times greater among NFL players, who also faced a 2.5 times higher risk of dying from heart disease.

In a related editorial, Zachary Y. Kerr, PhD, MPHof the department of exercise and sport science at the University of North Carolina at Chapel Hill, and colleagues wrote that the findings should be interpreted in the context of when the athletes studied played and the changes since then. “These findings are from professional athletes who played predominantly within the 1960s to 1980s. Of course, American-style football is a sport that allows for intentional contact, and there may be an inherent risk of injury involved for athletes of any era. Yet, American-style football has arguably evolved into a safer sport now in part owing to rules such as banning ‘spearing,’” they wrote. They further warned, “It is also essential to consider the heterogeneity in athlete profiles between that era and the modern era. As such, we urge readers to consider the generalizability of these findings to current professional American-style football players and, moreover, to the many active amateur American-style football players at the collegiate, high school and youth levels”.

Despite this evidence, it is also important to consider that longevity of both football and baseball players included in the study was longer than that of the general population. Similar concerns had arisen in the 90s when football players were reportedly not living beyond their 50s. At that time, NFL Players Association (NFLPA) asked researchers at the National Institute for Occupational Safety and Health (NIOSH) to look at the rate and causes of death among players. NIOSH is a government research agency within the Centers for Disease Control and Prevention (CDC). They conducted a study of 3,439 men who played for the NFL for at least five seasons during 1959 to 1988. They found that the players in their study had a much lower rate of death overall compared to men in the general population. This means that, on average, NFL players are actually living longer than men in the general population. They did find, however, that defensive linemen had a 42% higher risk of death from heart disease compared to men in the general population. They also found that players with a body mass index (BMI) of 30 or more during their playing years had twice the risk of death from heart disease compared to other players. Given that footballers in the JAMA Network Open study had, on average, a higher BMI than the baseballers, their findings could likely be partially driven by BMI.

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