Balady and Drezner Tackling Risks in College Football Players 479

Football players are widely recognized for their physical prowess. Decades of research have demonstrated that physical activity and fitness are associated with lower all-cause mortality and a variety of health benefits in healthy individuals and individuals with chronic diseases. The specific mechanisms responsible for these outcomes appear to be multifactorial and include a reduction in cardiovascular risk factors, and favorable effects on thrombosis, inflammation, endothelial function, and autonomic tone. However, a distinction must be made between competitive sports and recreational exercise, the latter from which the majority of research on the benefits of exercise are derived. The physiological and emotional demands during training and performance of competitive athletics are indeed quite different. Competitive athletes participate in an organized sport that rewards athletic excellence and achievement and requires systematic training and regular competition. Accordingly, these athletes characteristically extend themselves to high levels of effort for long periods of time, often doing so regardless of other considerations. Although the health benefits of regular exercise and physical activity are unequivocal, and overall cardiovascular risks during exercise and sports activities appear to be low, a small proportion of athletes often with undiagnosed pathological cardiac conditions are at risk of tragic cardiovascular events. Most known hazards described in football players are traumatic, and these include musculoskeletal injury and the newly described, very disturbing potential risk of chronic traumatic encephalopathy. Yet, sudden cardiac death is the leading medical cause of death and cause of death during exercise in National Collegiate Athletic Association student–athletes. A recent series demonstrates this risk to be 1:38 497 football players per year. Are there other, more insidious cardiovascular health risks to college football players perhaps incurred by the lifestyle, diet, and training demands of these players? This question is addressed by the provocative study by Weiner et al in this issue of Circulation.