Are athletes healthy?

Professor Sanjay Sharma is an expert in studying the heart and blood vessel health of athletes — he’s the Chair of the Expert Cardiac Committee of the Football Association (FA) and consultant cardiologist for top flight football clubs including Tottenham Hotspur, West Ham, Manchester City, Crystal Palace, Fulham and Southampton.

Alongside his team at St George, University of London, he uses his funding from the British Heart Foundation to help answer big questions about the heart health of athletes. But he’s also Medical Director of two fundraising powerhouses: the London Marathon and Prudential Ride London — so he’s no stranger to how hard-earned BHF donations are.

Improving the diagnosis of heart diseases in black athletes

Regular intense exercise can produce changes in the heart’s electrical activity, as shown by an ECG machine. Although these changes may simply be the heart adapting to exercise, similar results are also seen in people at risk of sudden cardiac death, the leading cause of mortality in athletes during sport and exercise. Recently, Fraser Franks, a 28-year-old professional footballer playing for Newport was diagnosed with heart problem and had to put an end to his career — athletes’ heart health must be closely monitored.

But ECG abnormalities are six times more common in athletes of African or African-Caribbean ethnic origin compared with other athletes. The recommendations for monitoring heart rhythms (developed in 2010) derived mostly from white amateur Italian athletes which didn’t consider ethnic background in interpreting athletes’ ECG results.

In 2012, the BHF funded a project led by Professor Sharma to investigate the heart health of African-Caribbean athletes to help design better guidelines and identify athletes at risk of sudden cardiac death and enable those who are not at risk to continue their careers.

This led to the development of new international criteria that were tested among African-American NBA players in 2018. These new guidelines lowered the false-positive rates from 40 per cent using the 2010 thresholds, to almost 15 per cent, a huge improvement but still a relatively high false-positive rate. The team are working to better understand the discrepancies between athletes depending on their ethnicity.

Professor Sharma said: “We are currently following up a large cohort of black athletes with abnormal ECGs to determine whether they will go on to develop heart diseases or have an adverse cardiac event. We are also performing genetic tests to understand whether these abnormal patterns are a marker of potentially serious cardiac disease in this group.”

What is the effect of life-long exercise on the heart and its blood vessels?

Professor Sharma also received funding from the BHF to look at the relationship between years of endurance exercise and the development of coronary artery disease, the build-up of fatty material (also called atherosclerosis) in the vessels that supply the heart with blood.

Some athletes, usually considered at low-risk for heart disease, can still develop more coronary artery disease and show more evidence of so called ‘silent’ heart attacks than healthy people who exercise in moderation — but we don’t know why.

In this project, Professor Sharma and his team are studying the heart function and risk factors in healthy endurance athletes aged 40–65.

“Our work has shown that just over 1 in 10 middle-aged life-long male runners have high calcium in the lining of the blood vessels of the heart (a marker of ‘wear and tear’ damage). We have also shown that a similar percentage of participants have scar tissue in their heart muscle. We are now trying to find out why some men have this and others don’t by investigating the association with exercise duration, diet and blood pressure responses during exercise.”

By identifying the risk factors contributing to the development of coronary artery disease in athletes, Professor Sharma and his team want to provide guidance for doctors when advising about the potential risks of endurance exercise, allowing older athletes to safely pursue their sporting endeavours.

Are women’s hearts aging more slowly than men’s?

In the same study, the team at St George’s compared the heart health of male and female runners of similar age and made some interesting findings:

“We noticed that none of the women in our group showed wear and tear damage in their heart blood vessels or scar tissue in their heart muscle. BUT only 30 per cent of the group we studied were women and they were the same age as the men (around 55 years old). It is possible that we didn’t have enough people in our study to see the same results in women, or perhaps the fact that women’s heart and circulatory systems age around 10 years slower than men’s? Now we want to do a larger study in older women to get to the bottom of these fascinating, and possibly life saving, questions.”

There are lots of ways we can try to keep our hearts healthy, but there is still so much we don’t know about the heart and circulatory system — even for those who we might think of as ‘perfect’ examples of physical fitness. At the BHF, we are committed to beating heartbreak forever, for everyone.

Find out more about keeping your heart healthy