Knowledge of cardiovascular risk patterns among professional athletes residing in rivers state, Nigeria

An athlete is defined by the Webstar English dictionary, as an individual that participates in a sporting activity, such as running, swimming, walking, football, table tennis and any other recreational or competitive activity that involves physical exertion and energy expenditure. Athletic activities require physical, mental and emotional wellbeing for an optimal output. Thus, the cardiovascular system is important and its role is very critical to the athlete, as it contributes to the overall performance of the athlete. However, it suffices to observe that most professional athletes have little or no knowledge of their cardiovascular status and the risks of developing cardiovascular impairment. This may be due to inadequate enlightenment of the risk factors that may enthrone cardiovascular diseases.

The heart and cardiovascular system being vital components of the human body must function effectively for optimal daily activity, while for the athlete, it is important that the heart functions optimally, as any deviation from normalcy will impact negatively on the performance in sporting activities. Therefore, cardiac screening is important, to frequently monitor and ascertain the cardiac status of the individual. However, cardiac screening among athletes remains a huge and yet-to-be adequately resolved concern among cardiovascular experts and medical scientists (Schmehil et al., 2017).

Athletic activities have evolved into a source of employment and financial enrichment (Oladunni & Sanusi, 2013). Apart from these, a successful athletic career also confers celebrity status and global recognition on the athlete. This has largely endeared individuals to sports and other forms of athletic activities. Owing to the physical exertion involved in athletic activities, the body tends to cope with challenging requirements for cardiovascular homeostasis, thermoregulatory control and the upkeep of muscle energy (Oladunni & Sanusi, 2013). This is in addition to immunosuppression, occasioned by the exertion, which exposes athletes to opportunistic infections (Oladunni & Sanusi, 2013). By implication, any impairment or defect in any of the mechanisms will impact negatively on the athlete’s health and performance. The impairment in health is sometimes immediate, but may be the remote cause for future debilitative health conditions, such as cerebrovascular disease (CVD) and metabolic disorders such as diabetes mellitus.

There has been a steady rise in the incidence of athlete’s death globally, mainly associated with cardiovascular disorders (Maron et al., 2009). This has led to a reduced participation in active or competitive sports (Kovacs & Baggish, 2015; Schmehil et al., 2017). The first step, therefore, is for the athlete and managers of sporting activities to understand the important role of the cardiovascular system in the overall performance and general wellbeing of the athletes. This entails continuous screening of their cardiovascular function (Maron & Pelliccia, 2016). However, there has been reported difference in cardiac function and structure among people of different race, including athletes (Uberoi et al., 2011).

In some countries like Turkey, Brazil and Uruguay, cardiovascular diseases have been observed to be the leading cause of morbidity and mortality (Andsoy et al., 2015), accounting for approximately 295,457 (47.73%) deaths in the country (T. C. Ministry of Health, 2010). Globally, an estimated 44 million youths participate in sporting activities each year, about 10 million at the high school level and approximately half a million at the college level (Kovacs & Baggish, 2015). Majority of these athletes lack knowledge of their cardiovascular status. Kovacs and Baggish (2015) posit that some of them may even have a pre‐existing heart disease, such as congenital heart disease, before indulging in the strenuous sporting schedules. The global prevalence of sudden cardiac death among athletes is estimated at 0.61 in 100,000 (Maron et al., 2009). The rarity of its occurrence does not suffice the fact that if appropriate measures are not taken to monitor cardiac function and status among this group of individuals (athletes), the occurrence of deaths attributable to cardiovascular dysfunction is not significant. However, this can be completely prevented or reduced, if proper modalities are put in place to monitor and diagnose its existence among athletes.

The risk factors for cardiovascular diseases are broadly grouped into modifiable and non-modifiable. Modifiable factors can be altered with a change in lifestyle, but not non-modifiable risk factors, which are mostly natural in development. Modifiable risk factors include: dyslipidemia, hypertension, diabetes mellitus, overweight, obesity, smoking, drugs and chemical substances, physical inactivity (sedentary lifestyle) and unhealthy diet, while the non-modifiable are age, sex and family history (D’Agostino et al., 2008; Yusuf et al., 2004). Some kinds of sport also serve factors for developing cardiovascular diseases, as reported for the American National Football League, where they are 52% more likely to gain weight and developing coronary heart disease mortality (Matthew & Wagner, 2008), thus, formulation of sport nutrition guidelines, to optimize the health and performance of athletes (Ray & Fowler, 2004; Rodriguez et al., 2009).

There has also been dispute on the authenticity that regular and rigorous exercise improves health. While some authors posit that it is of benefit to the human body, others argue otherwise, with a study from the Copenhagen Heart Study reporting that vigorous jogging presents similar heart rates as those without any form of exercise, hazard ratio, 1.97; 95% CI, 0.48-8.14; and hazard ratio, 0.66; 95% CI, 0.32-1.38, respectively (Schnohr et al., 2015). Another study also reported that about 20% of athletes who undertake endurance sports, such as marathon, have an increased left atrium, hypertrophy (Maron & Pelliccia, 2006). Maron and Pelliccia (2006) also reported abnormal patterns of echocardiography and other cardiovascular findings in about 40% of trained athletes, in addition to transient arrhythmias and cardiac conduction alteration.

Some athletes indulge in the use of drugs to boost their performance during training and competitive activities (Holmes et al., 2013). The role of drugs and other chemicals in the etiology of cardiovascular diseases cannot be underestimated, but they alter vascular and other systems functions. The negative effects of drugs and abuse of substance among professional athletes is in the public glare, with notable retired athletes coming down with severe neuromuscular complications and defects as their age advances. Among the commonly used and often abused drugs among professional athletes are steroids and non-steroidal anti-inflammatory drugs (NSAIDs) (Matz, 2011).

This aspect of sports is broadly lacking in most climes, mainly due to constraints of finance, facilities and other factors. At the moment, there is no standard for the screening of athletes and possible evaluation of cardiovascular abnormalities among them, which is a huge concern to clinicians and athletes (Schmehil et al., 2017). In a study on the sensitivity and specificity of cardiovascular screening results, about 68% of the respondents were observed to have an existing cardiac abnormality; a further review observed that about half were false positive results, while another 31% went for further screening and were observed to not have any form of heart-related abnormality (Harmon et al, 2015). Although cardiovascular disease among athletes resulting in unanticipated death is rare, it occurs. A study in the United States of America on the causes of sudden death among athletes, using its registry from 1980-2011, revealed that among 6,082 deaths, 842 were of cardiovascular origins with a male to female ratio of 6.5:1, with hypertrophic cardiomyopathy being the most common cause at 36%, while other cardiac causes were congenital coronary artery anomalies, arrythmogenic right ventricular cardiomyopathy and long QT syndrome (Maron et al., 2016). This is the situation in the region of this study, in addition to poor documentation, and this study intends to fill this gap.

The Health Belief Model was used for this study. The model explains the process of change in relation to health behaviour and is frequently used in health education, health promotion and disease prevention studies (Polit, 2004). Although the model was originally developed in 1850, it was expanded by Levential et al. (1928). The model breaks down health decisions into stages, providing catalogue of variables that influence health decisions and actions or inactions. However, it does not provide a pattern of exactly how these operate, but the likelihood that if an individual follows a preventive behaviour, it is likely influenced by subjective weighing of the costs and benefits of such actions. It is accompanied by some assumptions;

1. An individual will take a health-related action if the person feels that a negative health condition can be avoided.
2. An individual will take preventive action, having in mind that by taking a recommended action, the negative health conditions will be avoided, therefore, the person needs to see the benefits. If the benefits are not seen, it will be difficult to take action or maintain it.
3. The individual must feel confident that keeping to the recommended action, he or she has the necessary knowledge and skills in a supportive environment to carry out the required actions.

According to Onega (2000), the model comprises of three components; Individual perception- these are directly related to the person involved, the athlete, in this respect, Perceived susceptibility- it brings to bare certain health conditions/problems that the athletes must evaluate before embarking on an exercise, dietary or lifestyle regimen and Perceived seriousness: the notion about severity of the medical condition.