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Athletes may have doubled A-fib risk compared to general public

Journal
British Journal of Sports Medicine
Reuters Health - 13/07/2021 - Compared to the general population, athletes appear to have a nearly two-and-a-half-fold increased risk for atrial fibrillation, a new meta-analysis suggests.

Moreover, the data, pooled from 13 earlier studies, show that younger athletes and those who are involved in mixed sports, such as football, rugby and netball, appear to have the highest risk of the arrhythmia, researchers reported in the British Journal of Sports Medicine.

The researchers, led by Jamie O'Driscoll of Canterbury Christ Church University in the UK, call for large prospective studies "to address current gaps in the literature including female athletes and the effect of years and volume of training."

The 13 papers in the meta-analysis, published between 1990 and 2020, included seven cohort studies and six case-control studies involving a total of 6,816 athletes and 63,662 non-exercising or recreationally exercising controls.

Overall, the researchers found a 2.46 fold higher risk of atrial fibrillation among athletes compared to controls. But when they focused in on certain subgroups, they found even higher risks. For example, when they compared athletes without cardiovascular disease risk factors to controls without heart disease, they found the athletes had a significantly higher relative risk: 3.7-fold higher. Moreover, athletes under age 55 had a 3.6 times higher risk compared to those who were older.

There was also a significant relationship between the mode of exercise and risk of atrial fibrillation, with mixed sports conferring a greater risk than endurance sports. Of the endurance sports, cycling conferred the greatest risk of atrial fibrillation and Nordic skiing conferring the lowest risk.

"The reason by which exercise contributes to an increase in AF are not well understood and are likely complex," O'Driscoll told Reuters Health by email. "However, previous work suggests triggers (which can include things such as sports supplements/drug use), changes in control of the cardiovascular system (such as activation of the nervous system seen during exercise or greater inhibition of the nervous system when at rest) as well as heart adaptations, such as enlarged heart chambers, which is seen following long term exercise training and/or raised inflammation in responses to exercise, as well as inherited or genetic factors may contribute to this risk."

"Athletes tend to know their bodies really well," he added, "so any change would probably be recognized, but this should be reported to their coach and/or GP, or club doctor. Our work highlights that athletes and coaches may need to be educated on the symptoms that are associated with AF (which can include interrupted sleep, fainting episodes, palpitations, and/or a change in the level of breathlessness/tiredness during exercise), so that they can see the importance of seeking appropriate medical advice, evaluation and/or intervention."

Dr. Sandeep K. Jain, a professor of medicine at the University of Pittsburgh School of Medicine who was not involved in the study, commented by email, "This meta-analysis combines the results of multiple studies and confirms prior reports of competitive athletes having an increased risk of atrial fibrillation."

"The overall theme is that with exercise, there may be 'too much of a good thing' in athletes," Dr. Jain said. "There are many cautions in this type of analysis in reaching broad conclusions -- we don't know more about the mechanisms and there is always selection bias of the studies chosen. Most importantly, routine exercise as per guideline recommendations is very important in risk factor reduction and actually lowering the risk of the development of atrial fibrillation in the general population, which is distinct to the population studied here in competitive athletes."

SOURCE: https://bit.ly/3xAWqBd British Journal of Sports Medicine, online July 12, 2021.

By Linda Carroll



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