Thomas Wesley Allen

Prevalence of Cardiovascular Disease Risk Factors Among National Football League Players

CONTEXT Concern exists about the cardiovascular health implications of large size among professional football players and those players who aspire to professional status. OBJECTIVES To assess cardiovascular disease (CVD) risk factors in active National Football League (NFL) players and to compare these findings with data from the Coronary Artery Risk Development in Young Adults (CARDIA) study. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional study of 504 active, veteran football players from a convenience sample of 12 NFL teams at professional athletic training facilities between April and July 2007. Data were compared with men of the same age in the general US population (CARDIA study, a population-based observational study of 1959 participants aged 23 to 35 years recruited in 1985-1986). MAIN OUTCOME MEASURES Prevalence of CVD risk factors (hypertension, dyslipidemia, glucose intolerance, and smoking). RESULTS The NFL players were less likely to smoke when compared with the CARDIA group (0.1% [n = 1]; 95% confidence interval [CI], 0%-1.4%; vs 30.5% [n = 597]; 95% CI, 28.5%-32.5%; P < .001). Despite being taller and heavier, NFL players had significantly lower prevalence of impaired fasting glucose (6.7% [n = 24]; 95% CI, 4.6%-8.7%; vs 15.5% [n = 267]; 95% CI, 13.8%-17.3%; P < .001). The groups did not differ in prevalence of high total cholesterol and low-density lipoprotein cholesterol (LDL-C), low high-density lipoprotein cholesterol (HDL-C), or high triglycerides. Hypertension (13.8% [n = 67]; 95% CI, 11.0%-16.7%; vs 5.5% [n = 108]; 95% CI, 4.6%-6.6%) and prehypertension (64.5% [n = 310]; 95% CI, 58.3%-70.7%; vs 24.2% [n = 473]; 95% CI, 22.3%-26.1%) were significantly more common in NFL players than in the CARDIA group (both P < .001). Large size measured by body mass index (BMI) was associated with increased blood pressure, LDL-C, triglycerides, and fasting glucose, and decreased HDL-C. CONCLUSIONS Compared with a sample of healthy young-adult men, a sample of substantially larger NFL players had a lower prevalence of impaired fasting glucose, less reported smoking, a similar prevalence of dyslipidemia, and a higher prevalence of hypertension. Increased size measured by BMI was associated with increased CVD risk factors in this combined population.

Relationship of Collegiate Football Experience and Concussion With Hippocampal Volume and Cognitive Outcomes

IMPORTANCE Concussion and subconcussive impacts have been associated with short-term disrupted cognitive performance in collegiate athletes, but there are limited data on their long-term neuroanatomic and cognitive consequences. OBJECTIVE To assess the relationships of concussion history and years of football experience with hippocampal volume and cognitive performance in collegiate football athletes. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional study conducted between June 2011 and August 2013 at a US psychiatric research institute specializing in neuroimaging among collegiate football players with a history of clinician-diagnosed concussion (n = 25), collegiate football players without a history of concussion (n = 25), and non-football-playing, age-, sex-, and education-matched healthy controls (n = 25). EXPOSURES History of clinician-diagnosed concussion and years of football experience. MAIN OUTCOMES AND MEASURES High-resolution anatomical magnetic resonance imaging was used to quantify brain volumes. Baseline scores on a computerized concussion-related cognitive battery were used for cognitive assessment in athletes. RESULTS Players with and without a history of concussion had smaller hippocampal volumes relative to healthy control participants (with concussion: t48 = 7.58; P < .001; mean difference, 1788 μL; 95% CI, 1317-2258 μL; without concussion: t48 = 4.35; P < .001, mean difference, 1027 μL; 95% CI, 556-1498 μL). Players with a history of concussion had smaller hippocampal volumes than players without concussion (t48 = 3.15; P < .001; mean difference, 761 μL; 95% CI, 280-1242 μL). In both athlete groups, there was a statistically significant inverse relationship between left hippocampal volume and number of years of football played (t46 = -3.62; P < .001; coefficient = -43.54; 95% CI, -67.66 to -19.41). Behavioral testing demonstrated no differences between athletes with and without a concussion history on 5 cognitive measures but did show an inverse correlation between years of playing football and reaction time (ρ42 = -0.43; 95% CI, -0.46 to -0.40; P = .005). CONCLUSIONS AND RELEVANCE Among a group of collegiate football athletes, there was a significant inverse relationship of concussion and years of football played with hippocampal volume. Years of football experience also correlated with slower reaction time. Further research is needed to determine the temporal relationships of these findings.

Peer Review Guidance: How Do You Write a Good Review?

Peer review is essential to the quality of scientific publications. As the volume of submissions to these journals increases, the need for an expanding cadre of trained reviewers also increases. Many reviewers do not receive formal training on conducting a peer review or education on the peer review process, however. The author presents an overview of the peer review process and provides guidance for conducting high-quality reviews of manuscripts submitted to The Journal of the American Osteopathic Association and other scientific journals.

Sideline management of asthma

The timely, efficient, and effective sideline management of asthma must be based on an understanding of the disease processes, awareness of evidence-based therapeutic intervention, and thorough knowledge of the individual athlete’s past and present medical history. There is accumulating evidence that exercise-induced airway narrowing, if unrecognized or inadequately treated, can progress to a severe life-threatening status and should always be viewed as a potential medical emergency. A widening range of therapeutic measures is currently available to prevent and treat exercise asthma, and treatment must be tailored to the individual circumstances in order to optimize response.

An apple a day may keep cardiovascular disease at bay.

Patients with cardiovascular disease are living longer. Since 1950, deaths related to coronary artery disease have been slashed in half. This increased survival rate can be attributed to several factors. Among them are improved diagnostic procedures (Doppler ultrasound, intravascular ultrasound, angioscopy, contrast echocardiography) and interventional techniques (angioplasty, coronary bypass, thrombolytic therapy), as well as a greater availability of pharmacologic agents. Yet, despite an increase in the number of interventional cardiac procedures being performed (bypass procedures alone increased from an estimated 332,000 in 1987 to approximately 407,000 in 1991), the actual prevalence of cardiovascular disease has not declined to the extent that mortality has. Patients are still having myocardial infarctions and strokes. As managed care looms on the healthcarereform horizon, the economic feasibility of interventional cardiology will likely be scrutinized, particularly as it relates to clinical outcome. N ow more than ever, it seems appropriate to reemphasize the importance of preventive healthcare, particularly in cardiology. Research continues to show that diet and nutrition and exercise can significantly reduce the risks associated with cardiovascular disease. One small study found that patients with cardiovascular disease who were placed on a low-fat diet and an exercise and meditation regimen had a 9% decrease in arterial stenosis during a 4-year period. These study results were presented at the American Heart Assocations 66th Scientific Session, held in Atlanta, Ga, earlier this year. Devised by Dean Ornish, MD, of the Preventive Medicine Research Institute in Sausalito, Calif, this study also found that 72% of the 22 subjects had an actual reverse of their heart disease. Certainly, such a regimen deserves further large-scale study. Another group of agents with possible cardiovascular benefits are flavonoids. Polyphenolic antioxidants, flavonoids are found in fruits,