Association of athlete’s heart and ACE I/D genotype with later-life left ventricular hypertrophy: a retrospective cohort study

BACKGROUND: "Athlete's heart" refers to the physiological cardiac hypertrophy observed in competitive athletes, which reverts to normal after retirement from competition. However, few studies have examined long-term follow-up. This study investigated whether former college athletes with a history of an athlete's heart have a higher risk of developing heart disease later in life and examined its association with angiotensin-converting enzyme (ACE) insertion (I)/deletion (D) polymorphisms. METHODS: A total of 980 participants (mean age, 52.0 ± 15.7 years) from the Juntendo University Alumni Study were analyzed. Information on Athlete's heart during college and subsequent heart disease, including left ventricular hypertrophy, was obtained through self-administered questionnaires in 2018. The ACE I/D genotype was determined based on the rs4341 C/G polymorphism. RESULTS: Of all participants, 177 (18.1%) reported Athlete's heart during college, and 15 (1.5%) were diagnosed with left ventricular hypertrophy later in life. Former athletes with Athlete's heart had a 7.3-fold higher prevalence of left ventricular hypertrophy than those without such a history. Moreover, carriers of the D allele showed a further increased risk (odds ratio, 13.63; 95% confidence interval, 1.31-142.41). CONCLUSIONS: These findings suggest that regular cardiac monitoring may be warranted to identify potential late-onset cardiac remodeling in former athletes with Athlete's heart carrying the ACE D allele.