Bidirectional Interplay Between Traumatic Brain Injury and Cardiovascular Dysfunction in Athletes

Area of Science:

• Integrates neurology, cardiology, and sports medicine to address the cardiovascular impact of sports-related traumatic brain injury (TBI).
• Focuses on the intersection of neurotrauma and cardiovascular health in athletes.
• Highlights the under-recognized link between brain injury and cardiac outcomes.

Background:

• Sports-associated traumatic brain injury (TBI) is an emerging, under-recognized cause of acute and chronic cardiovascular diseases.
• Moderate-to-severe TBI is linked to a doubled risk of hypertension, coronary artery disease, myocardial infarction, and stroke for at least a decade.
• Concussions in athletes correlate with adverse cardiometabolic profiles and increased long-term stroke risk.

Purpose of the Study:

• To delineate acute neurocardiac complications following sports-related TBI.
• To synthesize evidence for chronic cardiovascular risk associated with TBI.
• To propose surveillance and therapeutic strategies for athletes with a history of TBI.

Main Methods:

• Integrates epidemiological, clinical, and mechanistic data from population-based studies and professional athlete cohorts.
• Reviews the pathophysiology of neurocardiac complications, including autonomic imbalance and neuroinflammation.
• Examines current sports-cardiology risk stratification and identifies gaps in addressing TBI history.

Main Results:

• Acute TBI triggers a 'sympathetic storm' leading to endothelial dysfunction, myocardial stunning, and arrhythmias.
• Chronic TBI effects include persistent autonomic imbalance (reduced heart-rate variability, impaired baroreflex sensitivity), neuroinflammation, and accelerated atherosclerosis.
• Athletes with higher concussion burdens show a more atherogenic profile and greater stroke risk.

Conclusions:

• Sports-related TBI is a significant, modifiable risk factor for long-term cardiovascular disease in athletes.
• Current risk stratification overlooks TBI history, necessitating a shift towards interdisciplinary care.
• Implementing strategies like heart-rate-variability-guided return-to-play and aggressive cardiometabolic risk modification can improve outcomes.