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HCM: Higher Risk for Black Athletes?

THE PHYSICIAN AND SPORTSMEDICINE - VOL 25 - NO. 5 - MAY 97


Hypertrophic cardiomyopathy (HCM), the most common cause of sudden death in young, competitive athletes, appears to be more common in black athletes than was previously thought, according to preliminary research findings (1). In fact, the research suggests that HCM may be a more common cause of sudden death for blacks athletes than for their white counterparts.

Previously, HCM was believed to be exceptionally rare in African Americans, according Barry J. Maron, MD, director of cardiovascular research at the Minneapolis Heart Institute Foundation. In 25 years of studying HCM, Maron says he has seen only a handful of blacks with HCM among nearly 3,000 cases. But his latest study, an analysis of 153 competitive athletes who died suddenly from various causes, tells a different story.

Of the victims, 64 (42%) were black and 84 (55%) were white (1). Overall, 32% (49) of the deaths were from HCM, but a higher proportion of blacks (28 of 64, 44%) died of the disease than whites (21 of 84, 25%). Most of the blacks were basketball or football players, and the average age was 17. The preliminary results of the study were presented at the annual meeting of the American College of Cardiology (ACC) in March in Anaheim, California.

The larger-than-expected number of HCM deaths in blacks and the racial difference in the HCM death rate are most likely due to differences in healthcare delivery, says Maron. "African-Americans are not afforded the same opportunities for healthcare, particularly for a disease that requires a particularly sophisticated cardiovascular diagnosis," he says. In a related ACC press release, Augustus O. Grant, MD, PhD, associate professor of medicine at Duke University Medical Center in Durham, North Carolina, noted that sudden death related to coronary artery disease in the black community may be more prevalent because patients aren't familiar with the symptoms and because care may be delayed.

Despite compulsory preparticipation examinations, most athletes who have HCM go undetected, and the first symptom is commonly sudden death, says Reginald L. Washington, MD, a pediatric cardiologist in Denver and an executive committee member of the American Academy of Pediatrics Sports Medicine Committee.

Because HCM is a rare disorder, an athlete who has a normal physical exam and no history of cardiovascular disease should not be screened with an electrocardiogram or echocardiogram, Washington says. Instead, the physician should ask specifically if the athlete or anyone in his or her family has had symptoms of dizziness, light-headedness, or shortness of breath, with or without exercise, and ask questions about any family history of sudden death, heart murmurs, fainting, pacemakers, or heart medications. "I always ask twice about symptoms," he says.

Washington suggests that athletes and parents fill out questionnaires for preparticipation physicals together. Then the physician should review the answers with the athlete. He suggests that a preparticipation history should be taken before each new sport. "An athlete could begin to pass out every time he lifts weights, or an uncle could have died suddenly," he says, adding that positive questionnaire responses would signal a need for further review.

Mark L. Fuerst
Brooklyn, New York

Reference

  1. Maron BJ, Poliac LC, Mathenge R: Hypertrophic cardiomyopathy as an important cause of sudden cardiac death on the athletic field in African-American athletes, abstracted. J Am Coll Cardiol 1997;29(2 suppl A):462A


Scanning Sports

A research report in the March/April issue of FitnessMatters, the journal of the American Council on Exercise in San Diego, says that abdominal "roller" machines are no better at strengthening the abdominal muscles than traditional strengthening exercises—basic crunches and oblique crunches—performed without the assistance of those devices.

Two drug companies have developed vaccines against Lyme disease. SmithKline Beecham Biologicals, based in Rixensart, Belgium, recently completed a trial involving 11,000 people who live in three regions of the United States: New England, the mid-Atlantic, and the Midwest. In a press release the company says it will file a product license application with the US Food and Drug Administration later this year. Pasteur Mérieux Connaught USA, in Swiftwater, Pennsylvania, is evaluating the results of a study on the Lyme disease vaccine it developed, according to a company spokesperson.

To measure the cardiac effects of deer hunting, researchers sent hunters out into the field with Holter monitors and diaries to record their activities (see "When the Buck Stops the Heart," April 1997). Writer Carol Potera asked researcher Susan Haapaniemi, MS, how adept the hunters were at remembering and recording what went on during the pursuit. Her response lends credence to the theory that men are from Mars and women are from Venus: "These hunters remember the details of shooting a deer the way a woman remembers having a baby," says Haapaniemi.


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