Clinical study: hypertrophic cardiomyopathy
Relationship of race to sudden cardiac death in competitive athletes with hypertrophic cardiomyopathy

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Abstract

Objectives

The goal of this study was to determine the impact of race on identification of hypertrophic cardiomyopathy (HCM).

Background

Sudden death in young competitive athletes is due to a variety of cardiovascular diseases (CVDs) and, most commonly, HCM. These catastrophes have become an important issue for African Americans, although HCM has been previously regarded as rare in this segment of the U.S. population.

Methods

We studied the relationship of race to the prevalence of CVDs causing sudden death in our national athlete registry, and compared these findings with a representative multicenter hospital-based cohort of patients with HCM.

Results

Of 584 athlete deaths, 286 were documented to be due to CVD at ages 17 ± 3 years; 156 (55%) were white, and 120 (42%) were African American. Most were male (90%), and 67% participated in basketball and football. Among the 286 cardiovascular deaths, most were due to HCM (n = 102; 36%) or anomalous coronary artery of wrong sinus origin (n = 37; 13%). Of the athletes who died of HCM, 42 (41%) were white, but 56 (55%) were African American. In contrast, of 1,986 clinically identified HCM patients, only 158 (8%) were African American (p < 0.001).

Conclusions

In this autopsy series, HCM represented a common cause of sudden death in young and previously undiagnosed African American male athletes, in sharp contrast with the infrequent clinical identification of HCM in a hospital-based population (i.e., by seven-fold). This discrepancy suggests that many HCM cases go unrecognized in the African American community, underscoring the need for enhanced clinical recognition of HCM to create the opportunity for preventive measures to be employed in high-risk patients with this complex disease.

Abbreviations

ARVC
arrhythmogenic right ventricular cardiomyopathy
CVD
cardiovascular disease
HCM
hypertrophic cardiomyopathy
LV
left ventricle/ventricular

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