Electrocardiographic findings and cardiovascular risk profile in paralympic athletes

Type of funding sources: None.

Paralympic athletes are a special group of elite athletes with unique cardiovascular issues. Recently, the term "Paralympic medicine" has been used to describe the specific medical conditions of athletes participating in the Paralympics. However, there are limited data regarding cardiovascular screening in Paralympic athletes.

To assess the prevalence of normal and abnormal cardiac findings and cardiovascular risk factors in a subset of male Paralympic athletes.

From April 2019 to July 2021, male Paralympic athletes who were selected for participation in Paralympic Games in non-endurance sports disciplines, underwent cardiac screening including history, physical examination, 12-leads electrocardiogram (ECG), echocardiography and blood test. Athletes were classified according to the sports disciplines into three groups: 1) skill (archery, shooting, taekwondo, judo); 2) power (weightlifting, discus throwing, shot putting, javelin throwing) and 3) mixed (sitting volleyball, wheelchair basketball, rowing). As well as divided base on the type of disability into two groups: 1) athletes with spinal cord injury (SCI), and 2) athletes with non-spinal cord injuries (NSCI). All ECG were interpreted according to international recommendations for ECG interpretation in athletes.

Among 82 Paralympic athletes (mean age, 33.7 [21-49] years), there were 19 (23%) in skill, 25 (31%) in power, and 38 (46%) in mixed sports disciplines and 24 (30%) had SCI and 58 (70%) had NSCI. There were no abnormalities observed in two-dimensional echocardiography. Normal ECG findings were seen in 28 athletes (34.1%) with a higher prevalence in athletes with NSCI (41.3%) and participated in mixed (47.3%) sports discipline (p<0.001). Borderline ECG findings were detected in 6 (7.3%) with more frequent in athletes with SCI (12.5%) and participated in power (16%) sports disciplines (p<0.001). The prevalence of abnormal ECG findings were 3.6% and there was no significant difference regard to type of disability and sports disciplines. Cardiac risk factors including hypertension was detected in 8 (9.7%); triglycerides >200 mg/dl in 21 (25.6%), total cholesterol >200 mg/dl in 15 (18.2%), 25-hydroxyvitamin D3 <30 ng/ml in 35 (42.6%), low-density lipoprotein cholesterol >130 mg/dl in 8 (9.7%), very low-density lipoprotein cholesterol ≥50 mg/dl in 15 (18.2%) and high-density lipoprotein cholesterol <40 mg/dl in 7 (8.5%); that were significantly more frequent in athletes with SCI and athletes participated in power sports disciplines (p<0.001).

The overall prevalence of borderline ECG findings and cardiovascular risk factors are unexpectedly high in Paralympic athletes. This study emphasizes that Paralympic athletes especially those with SCI and participating in power sports disciplines are not immune from cardiovascular risk factors and requires more medical care attention through relevant cardiovascular screening strategies.