Cardiovascular and metabolic effects of hyperbilirubinemia in a cohort of Italian Olympic athletes

Influence of Persistently Elevated LDL Values on Carotid Intima Media Thickness in Elite Athletes

INTRODUCTION

Carotid IMT is a recognized marker for early atherosclerotic changes and a predictor of future CV events. Previous studies showed 11% increased risk of myocardial infarction with each 0.1 mm incremental increase of carotid IMT. In general population, LDL cholesterol levels are positively correlated with carotid IMT in both cross-sectional and longitudinal studies while its role in elite athletes remains understudied.

AIM

This study aimed to investigate the correlation between persistent lipid profile alterations and early markers of atherosclerosis, specifically carotid IMT, in a cohort of elite athletes.

METHODS

We included 302 athletes serially evaluated for a prolonged time period. Anthropometric data, blood tests for lipid profiles, and carotid IMT measurements were collected. Dyslipidemia was defined as LDL ≥ 116 mg/dL, and persistent elevation when LDL values remained above the threshold limits in at least three pre-participation screenings. Categorical variables were expressed as frequencies and percentages and were compared using Fisher's exact test or Chi-square test, as appropriate.

RESULTS

91 athletes (30.1%) had persistently elevated LDL levels. Dyslipidemic athletes were older (30.7 ± 5.7 vs. 29.1 ± 4.1 years, p = 0.008), had higher BMI (p = 0.032), and a higher prevalence of obesity (5.5% vs. 0.5%, p = 0.004) compared to those with normal lipid profiles. Additionally, they had higher total cholesterol (p < 0.0001) and triglycerides (p < 0.0001) but similar HDL levels (p = 0.213). Globally, athletes with altered LDL profiles over long-time period showed higher IMT (0.60 ± 0.10 mm vs. 0.57 ± 0.07 mm, p = 0.014). In particular, longer exposure to elevated LDL was significantly associated with increased IMT (0.61 ± 0.12 mm vs. 0.57 ± 0.06 mm, p = 0.035).

CONCLUSIONS

Our study highlights the association between persistently elevated LDL-C and increased carotid IMT in elite athletes, with longer exposure time correlating with more pronounced carotid changes. These findings underscore the importance of regular monitoring of blood lipid profiles and carotid IMT measurements as a non-invasive, cost-effective method to prevent atherosclerotic vascular disease.

Lipid Accumulation Product and Cardiometabolic Index as Effective Tools for the Identification of Athletes at Risk for Metabolic Syndrome

INTRODUCTION

Metabolic syndrome (MS) is a growing global public health concern that is associated with increased risk for cardiovascular events, even in athletes. The lipid accumulation product (LAP) index and cardiometabolic index (CMI) have been shown to be efficient markers of MS in the general population; its applicability in athletes has not been discussed yet. We aimed to assess the role of LAP and CMI in predicting MS in athletes.

METHODS

We retrospectively enrolled 793 Olympic athletes practicing different sporting disciplines (power, skill, endurance, and mixed), classified arbitrarily into no risk (NR), low risk (LR), high risk (HR), or MS if they had 0, 1, 2, or 3 criteria for MS, respectively. Evaluations included a calculation of the LAP index, CMI, anthropometric measurements, and clinical and laboratorial variables.

RESULTS

Among our population, only 0.8% reached the criteria for MS, 9.1% were at HR for MS, 37.8% were defined as LR, and 52.3% had NR. Significant differences in anthropometric parameters and the principal components of MS criteria (blood pressure, lipidic profile, glycemia) were reported predominantly in HR athletes and those with MS (p < 0.0001). LAP and CMI presented linearly increasing values from individuals with NR to those with MS (p < 0.0001). In addition, HR and MS athletes were classified as "likely MS" (9.8%) and LR and NR athletes as "unlikely MS" (90.2%). After adjusting for potential confounders, LAP ≥ 34.66 and CMI ≥ 0.776 emerged as independent predictors for MS in the overall cohort (Hazar Ratio (HR) 7.22 [3.75-13.89], p < 0.0001, and HR 5.37 [2.96-9.73], p < 0.0001, respectively). The ROC curve revealed that these cut-offs in the general population predict MS with an area under the curve (AUC) of 0.80 and 0.79, respectively, for LAP and CMI. However, gender-related cut-offs seem to be more precise in predicting MS (LAP ≥ 38.79 for male, LAP ≥ 14.16 for female, and CMI ≥ 0.881 for male and ≥0.965 for female).

CONCLUSION

The ROC curve analyses of LAP and CMI showed good diagnostic accuracy in predicting MS among athletes, despite the low prevalence of MS in our sample. Thus, these indexes may be used to promote screening for primary prevention and early detection of athletes at risk for MS to establish an early prevention strategy. Larger prospective studies are necessary to validate their benefit in the general population.

Determinants of supraventricular extra beats in elite athletes practicing different sporting disciplines

BACKGROUND

Supraventricular extra beats (SVEB) are frequently observed in athletes but data on significance, prognostic role and correlation with cardiac remodeling are contrasting. It is uncertain whether SVEB may indicate the development of more complex arrhythmias and the need for closer monitoring is undetermined. The aim was to assess the prevalence and clinical significance of BESV in Olympic athletes of different sporting disciplines, evaluating potential correlations with cardiac remodeling and clinical features.

METHODS

We enrolled athletes who participated at 2012-2022 Olympic Games, submitted to physical examination, blood tests, echocardiography and exercise tests, categorized into power, skills, endurance and mixed disciplines.

RESULTS

We studied 1492 elite athletes: 56% male individuals, mean age 25.8 ± 5.1 years; 29.5% practiced power, 12.3% skills, 21% endurance and 37.2% mixed disciplines. At exercise-stress tests, 6.2% had SVEB, mostly single beats. SVEB were not influenced by anthropometrics or blood test results. They were more common in male individuals (77.4 vs. 54.6%, P < 0.0001) and older athletes (27.1 ± 5.7 vs. 25.7 ± 5.1, P = 0.01). In male athletes with SVEB, higher left atrial volumes were observed (24.2 ± 7.3 vs. 22.2 ± 7.1 ml/m2, P = 0.03). No differences were found in terms of sporting discipline: despite larger left atrial dimensions in aerobic disciplines, SVEB rates were similar in different sporting disciplines (6.1% endurance, 6.3% mixed, 5.2% power and 8.7% skills; P = 0.435).

CONCLUSION

SVEB were more common in older, male athletes and associated with higher left atrial volume (especially in male individuals) regardless of sport practiced. Athletes with greater left atrial volume and SVEB are supposed to have higher risk, in middle age, of developing more complex arrhythmias.

Lack of cardiac remodelling in elite endurance athletes: an unexpected and not so rare finding

PURPOSE

Endurance elite athletes are expected to present a cardiac remodelling, characterized by eccentric hypertrophy (EH), may be associated with higher sportive performances. However, not all can present a cardiac remodelling. The study aimed to identify endurance athletes without cardiac remodelling characterizing their physiologic and clinical features.

METHODS

We studied 309 endurance athletes (cycling, rowing, canoeing, triathlon, athletics, long-distance swimming, cross-country skiing, mid-long distance track, pentathlon, biathlon, long-distance skating and Nordic-combined) examined during period of training, by clinical evaluation, ECG, echocardiogram and exercise-stress test. Sport career achievements (Olympic\World championship medals or national\world records) were recorded.

RESULTS

EH was found in most of athletes, (n = 126, 67% of males; n = 85, 68.5% of females). A significant proportion,, exhibited normal geometry (NG) ( n = 59, 31.3% in males; n = 39, 31.4% in females). At stress test, significant differences between EH and NG athletes were found in peak power (317.1 ± 71.2W in NG vs. 342.2 ± 60.6W in EH, p = 0.014 in males and 225.1 ± 38.7W in NG vs. 247.1 ± 37W in EH, p = 0.003 in females), rest heart rate (66.1 ± 13 in NG vs. 58.6 ± 11.6 in EH, p = 0.001 in males and 68 ± 13.2 in NG vs. 59.2 ± 11.2 in EH, p = 0.001 in females) with similar ventricular extrasystoles (p = 0.363 in males and p = 0.492 in females). However, no significant differences in athletic achievements were registered.

CONCLUSION

Our study demonstrates a relatively high prevalence of NG in endurance athletes, in addition to the expected EH. Athletes with NG perform worse in exercise-stress test and exhibit some less advantageous functional heart characteristics. However, the type of heart geometry is not associated with negative clinical findings.

Association between FT3 Levels and Exercise-Induced Cardiac Remodeling in Elite Athletes

BACKGROUND

Previous studies demonstrated that variations of fT3, even within the euthyroid range, can influence cardiac function. Our aim was to investigate whether thyroid hormones, even within the euthyroid range, are associated with the magnitude of exercise-induced cardiac remodeling in Olympic athletes.

METHODS

We evaluated 1342 Olympic athletes (mean age 25.6 ± 5.1) practicing different sporting disciplines (power, skills, endurance, and mixed). Athletes underwent blood testing (thyroid stimulating hormone, fT3, and fT4), echocardiography, and exercise-stress testing. Athletes taking thyroid hormones, affected by thyroiditis, or presenting TSH out of ranges were excluded.

RESULTS

The level of thyroid hormones varied according to the type of sporting discipline practiced: endurance athletes presented the lowest TSH (p < 0.0001), fT3 (p = 0.007), and fT4 (p < 0.0001) in comparison to the remaining ones. Resting heart rate (HR) was positively correlated to fT3 in athletes of different disciplines (power: p = 0.0002, R2 = 0.04; skill: p = 0.0009, R2 = 0.05; endurance: p = 0.007, R2 = 0.03; and mixed: p = 0.04, R2 = 0.01). The same results were seen for peak HR in the exercise-stress test in athletes engaged in power, skill, and endurance (respectively, p < 0.0001, R2 = 0.04; p = 0.01, R2 = 0.04; and p = 0.005, R2 = 0.02). Moreover, a positive correlation was observed with cardiac dimensions, i.e., interventricular septum (power: p < 0.0001, R2 = 0.11; skill: p = 0.02, R2 = 0.03; endurance: p = 0.002, R2 = 0.03; mixed: p < 0.0001, R2 = 0.04). Furthermore, fT3 was directly correlated with the left ventricle (LV) end-diastolic volume in skills (p = 0.04, R2 = 0.03), endurance (p = 0.04, R2 = 0.01), and mixed (p = 0.04, R2 = 0.01).

CONCLUSIONS

Thyroid hormones, even within the euthyroid range, are associated with cardiac adaptive response to exercise and may contribute to exercise-induced cardiac remodeling.