Nonsteroidal Anti-inflammatory Drugs and Cardiovascular Risk in American Football.

INTRODUCTION Non-steroidal anti-inflammatory drugs (NSAIDs) are associated with adverse cardiovascular outcomes and reportedly overused in American-style football (ASF). However, assessment of ASF NSAID use in the context of cardiovascular risk has not been performed. We sought to characterize NSAID use patterns and the association with cardiovascular risk in a diverse cohort of high school and collegiate ASF athletes. METHODS 226 ASF athletes, 60 endurance athletes, and 63 non-athletic controls were studied pre- and post-season with echocardiography, vascular applanation tonometry, and clinical data assessment. Qualitative NSAID use throughout the season was recorded at post-season. RESULTS ASF athletes gained weight (Δ0.86±3.9kg, P<0.001), increased systolic blood pressure (SBP, Δ3.1±12mmHg, P<0.001) and pulse wave velocity (PWV, Δ0.2±0.6m/s, P<0.001), and decreased E' (Δ-1.4±2.8cm/s, P<0.001) across one athletic season. 77% (N=173) of ASF athletes reported sport-specific NSAID use began in middle school. ASF NSAID use was more frequent with 'weekly' (N=42,19%) and 'daily' (N=32,14%) use compared to endurance athletes (P<0.001) and controls (P=0.02). ASF NSAID use increased in parallel with post-season SBP and weights. 'Daily' ASF NSAID users demonstrated the highest post-season SBP (137±13 vs. 128±13mmHg, P=0.002) and weight (109.0±18.6 vs. 95.8±20.5kg, P=0.002) compared to 'never/rare' users. Adjusting for player position, SBP, PWV, and E', increased weight (OR:1.04, 95%CI 1.0-1.08, P=0.037) was associated with more frequent NSAID use. CONCLUSIONS Habitual NSAID use commonly begins during adolescence, before full physical maturation, and is associated with cardiovascular risk, particularly increased weight, in ASF athletes. NSAID use frequency should be considered when risk stratifying high-risk ASF athletes.