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J Am Coll Cardiol, 2003; 41:974-980, doi:10.1016/S0735-1097(02)02976-5 © 2003 by the American College of Cardiology Foundation |
* Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
Cleveland Clinic Foundation, Cleveland, Ohio, USA
University of Florida Health Sciences Center, Gainesville, Florida, USA
St. Luke’s-Roosevelt Hospital Center, New York, New York, USA
Manuscript received December 27, 2001; revised manuscript received September 24, 2002, accepted October 25, 2002.
* Reprint requests and correspondence: Dr. Barry J. Maron, Minneapolis Heart Institute Foundation, 920 East 28th Street, Suite 60, Minneapolis, Minnesota 55407, USA.
hcm.maron{at}mhif.org
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.
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