How Do We Address Racial Disparities in Sports Cardiology?

Abstract

Black individuals in the United States experience a disproportionate burden of cardiovascular disease, driven by higher prevalence of traditional risk factors such as hypertension, diabetes, obesity, and hyperlipidemia, as well as the enduring impact of structural racism, socioeconomic inequality, and environmental injustice. These disparities contribute to elevated cardiovascular mortality and sudden cardiac death, including among competitive athletes. Additionally, Black athletes face a higher risk of cardiac arrest and are more likely to have preparticipation electrocardiograms misclassified as abnormal, which can lead to inappropriate disqualification from sport. Current diagnostic standards reinforce systemic bias and perpetuate the myth of biological racial determinism. Instead, a race-conscious approach - one that integrates the social determinants of health, develops inclusive diagnostic reference ranges, and ensures equitable access to preventive care - can reduce false positives, improve risk stratification, and foster more equitable clinical decision-making. Addressing these disparities requires comprehensive strategies, including upstream investment in equitable health systems and downstream implementation of culturally competent, evidence-based care tailored to athletes' needs. By shifting the focus from race as a biological construct to race as a proxy for structural inequities, sports cardiology can advance toward a more just and prevention-focused model that improves cardiovascular outcomes for all athletes.