Black athletes are up to five times more likely than white ones to die from sudden cardiac arrest, according to a new paper published Thursday in a leading medical journal.
Authors of the paper, which include lead author Dr. Jonathan Kim, founding director of Emory’s Sports Cardiology Program, are calling for more research on “social determinants of health” — built-in stressors and resource gaps that are often associated with racial disparities. The authors say they don’t believe genetics explains the difference seen between the races, and there’s not enough research to make a conclusion.
Kim said the findings could have implications for young people generally, whether or not they’re athletes. “This is about what happens every day and among schools in America,” said Kim, who is himself a runner. “This is about the health of school aged children, and trying to understand that.”
The paper, published in the Lancet, a British medical journal, looked at school-age athletes and veteran ones, both at those who compete officially and those who are active amateurs.
For the paper, an international research team led by Kim combed through the scattered research on sudden cardiac death among athletes: looking at how often it happens and what is known and unknown about the causes and prevention. Too much is unknown, they said.
Sudden cardiac arrest among athletes is uncommon, especially among the young. But it may be a harbinger of larger issues affecting health. A similar phenomenon exists with maternal mortality, where new moms in Georgia are more than twice as likely to die within a year of giving birth if they’re Black females. Understanding why might prompt strategies that not only save lives but also improve the chances of health generally.
“I think what’s new is asking the question “Why?” and appreciating that we don’t understand what explains these disparities and outcomes,” Kim said.
Social determinants of health and sports
Not everyone has a sudden cardiac arrest because of their own health. For example, in a moment watched on-screen by millions, professional football player Damar Hamlin was hit in a specific spot on his chest during a play, a fluke that caused his heart to stop on live TV. He would almost certainly have died but the medical team knew immediately what to do and had the tools, including a defibrillator, at the scene. Hamlin survived.
For some cardiac arrests, there may be underlying contributors that make all the difference. Sometimes those are medical conditions. Sometimes they’re a mystery.
Finding what those might be is about data, Kim said.
“This is looking at health outcomes, which are very much driven by these environmental stressors that clearly exist,” Kim said.
Historically, research made the case that genetic diseases of the heart caused the largest number of cardiac arrests in athletes, the paper said, but there were flaws. One prominent source of that historic research on genetic heart conditions actually skipped over a large number of cases, the Lancet paper reported, because the autopsy reports didn’t find any problem with the heart, or an autopsy wasn’t performed.
Recent research into cardiac cases in athletes is starting to look at social determinants of health.
For example, everyone knows that eating fresh foods, getting good sleep and managing stress levels lead to better heart health.
But on average, food deserts where grocery stores are scarce, and low-income areas where people can’t afford their own cars, are more likely to include Black people than white people. Those things can help determine whether they can eat fresh food as often or get home in time for a good sleep.
“It’s not necessarily a choice, right? It’s kind of where you grow up,” Kim said. In addition, he said, there may be the stress of navigating life while being affected by discrimination. He emphasized the paper did not find research that indicated whether social determinants of health were behind athletes’ cardiac arrests.
“I think the idea is, is that we know that these factors play a role in outcomes in the general population, and they need to be explored,” he said.
One thing the Lancet report stated is that the findings should not be used to mandate preseason electrocardiogram tests for heart issues to screen out Black athletes from competition. Some think they should be required for all athletes. That’s a hot issue and a controversial one, Kim said.
One reason it’s controversial comes back to disparities: Black athletes have access to less accurate testing, and more often are the subject of false positives, the report said. That means that some young players who could get healthier through sports are mistakenly found to have a heart issue and screened out. In such a case, the ECG screening could then actually lead to worse health for the athlete.
Georgia mandates a general physical screening before participating in school sports, but not an ECG.
The findings on race persisted even though sudden cardiac arrest cases have declined overall. And men were more vulnerable than women.
The study counted veteran athletes as those 35 or older and strongly involved in sports. Cases among older athletes were generally associated with coronary artery disease. Among youth, cardiac events were often unexplained.
The one thing that can be done is mandating having a defibrillator and an action plan that gets regular practice at public gathering places. Georgia passed a law this year, House Bill 874, mandating them in public schools.
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