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July 17, 2024

Racial Disparities in Sports Cardiology: A Review

厂丑别别濒补听碍谤颈蝉丑苍补苍,听惭顿1; James Sawalla听Guseh,听MD2; 惭别谤颈箩别听颁丑耻办耻尘别谤颈箩别,听惭顿3; et al Aubrey J.听Grant,听MD4; Peter N.听Dean,听MD5; Jeffrey J.听Hsu,听MD, PhD6; Mustafa听Husaini,听MD, MBA7; Dermot M.听Phelan,听MD, PhD8; Ankit B.听Shah,听MD, MPH9; 碍补迟颈别听厂迟别飞补谤迟,听颁狈笔2; Meagan M.听Wasfy,听MD, MPH10; 蚕耻颈苍苍听颁补辫别谤蝉听滨痴,听惭顿11; Utibe R.听Essien,听MD, MPH12,13; Amber E.听Johnson,听MD, MSc, MBA14; Benjamin D.听Levine,听MD15,16; Jonathan H.听Kim,听MD, MSc17; for the American College of Cardiology Sports & Exercise Leadership Council
Author Affiliations Article Information
  • 1Cardiovascular Services, Division of Cardiology, Maine Medical Center, Portland
  • 2Cardiovascular Performance Program, Division of Cardiology, Massachusetts General Hospital, Boston
  • 3Sports and Exercise Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Cedars-Sinai Medical Group, Los Angeles, California
  • 4MedStar Heart & Vascular Institute, Baltimore, Maryland
  • 5Division of Pediatric Cardiology, Department of Pediatrics, University of Virginia, Charlottesville
  • 6Department of Medicine (Cardiology), David Geffen School of Medicine, University of California, Los Angeles
  • 7Division of Cardiovascular Medicine, Department of Medicine, Washington University in St Louis, St Louis, Missouri
  • 8The Gragg Center for Cardiovascular Performance, Atrium Health Sanger Heart & Vascular Institute, Charlotte, North Carolina
  • 9Sports & Performance Cardiology, Georgetown University School of Medicine, Chevy Chase, Maryland
  • 10Division of Cardiology, Massachusetts General Hospital, Boston
  • 11Department of Medicine, The University of Texas Southwestern Medical Center, Dallas
  • 12Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles
  • 13Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
  • 14Division of Cardiology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
  • 15Institute for Exercise and Environmental Medicine, Texas Health Presbyterian, Dallas
  • 16Department of Medicine and Cardiology, The University of Texas Southwestern Medical Center, Dallas
  • 17Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia
JAMA Cardiol. 2024;9(10):935-943. doi:10.1001/jamacardio.2024.1899
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Abstract

Importance听 Racial disparities in cardiovascular health, including sudden cardiac death (SCD), exist among both the general and athlete populations. Among competitive athletes, disparities in health outcomes potentially influenced by social determinants of health (SDOH) and structural racism remain inadequately understood. This narrative review centers on race in sports cardiology, addressing racial disparities in SCD risk, false-positive cardiac screening rates among athletes, and the prevalence of left ventricular hypertrophy, and encourages a reexamination of race-based practices in sports cardiology, such as the interpretation of screening 12-lead electrocardiogram findings.

Observations听 Drawing from an array of sources, including epidemiological data and broader medical literature, this narrative review discusses racial disparities in sports cardiology and calls for a paradigm shift in approach that encompasses 3 key principles: race-conscious awareness, clinical inclusivity, and research-driven refinement of clinical practice. These proposed principles call for a shift away from race-based assumptions towards individualized, health-focused care in sports cardiology. This shift would include fostering awareness of sociopolitical constructs, diversifying the medical team workforce, and conducting diverse, evidence-based research to better understand disparities and address inequities in sports cardiology care.

Conclusions and Relevance听 In sports cardiology, inadequate consideration of the impact of structural racism and SDOH on racial disparities in health outcomes among athletes has resulted in potential biases in current normative standards and in the clinical approach to the cardiovascular care of athletes. An evidence-based approach to successfully address disparities requires pivoting from outdated race-based practices to a race-conscious framework to better understand and improve health care outcomes for diverse athletic populations.

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