Author + information
- Kevin P. Cohoon, DO, MSc∗ ()
- ↵∗Department of Cardiovascular Diseases and Gonda Vascular Center, Mayo Clinic, 200 First Street, Southwest, Rochester, Minnesota 55905
I read with interest the paper “The Emergence of Sports Cardiology as a Specialty” by Afari (1) with commentary by Dr. Molossi. The emerging interest in early-career cardiovascular physicians treating the exercising individual through sports cardiology clinics is exciting and rewarding. As an early-career cardiologist with vascular medicine expertise, I share in this excitement. However, a large entity not considered in the letter to the editor is the vascular component in cardiovascular sports clinics. The management of cardio–vascular conditions to reduce the risk of sports-related events in athletes is complex. This area of interest, like many others, requires development of expertise and specialized multidisciplinary clinics. Due to the variety and complexity of vascular disorders in athletes, the subspecialty of vascular sports medicine specialists has emerged. We developed a novel and innovative multidisciplinary collaborative clinical practice and research program at Mayo Clinic that provides specialized care for the athlete with vascular disease(s), termed vascular sports medicine. Care is provided by cardiovascular and vascular medicine specialists who collaborate with sports medicine, physical medicine and rehabilitation, orthopedics, and other health care specialties to provide an individualized approach to the athlete.
The field of sports medicine includes many nonmusculoskeletal specialists, such as sports cardiologists, who focus on specific nonmusculoskeletal conditions that affect athletes, such as malignant arrhythmias, hypertrophic cardiomyopathy, and coronary congenital abnormalities. Similar to cardiac conditions, vascular disorders in athletes may be overlooked due to the lack of an appropriate index of suspicion. The spectrum of vascular disorders associated with athletes is broad and can affect the arteries, nerves, or veins in the upper or lower limb. Vasculopathic mechanisms can involve extrinsic compression (e.g., thoracic outlet syndrome, popliteal artery or vein entrapment syndromes, adductor canal syndrome, cystic adventitial disease of the popliteal artery, and May-Thurner syndrome), intrinsic vessel wall pathology (e.g., external iliac artery endofibrosis, iliac artery vasospasm, coarctation of the aorta, early atherosclerosis disease, fibromuscular dysplasia, and vasculitis), intraluminal disorders (e.g., deep vein thrombosis, embolic disease, arteriovenous malformations, anemia, and venous insufficiency), or vasospastic disorders. Vascular disorders that remain undiagnosed for a prolonged period can have devastating, career-ending consequences, whereas early diagnosis facilitates a return to previous levels of activity.
Access to a vascular sports medicine specialist should be integral to any sports medicine program. There are several routes by which physicians can acquire training in vascular sports medicine. These include completion of a vascular medicine or cardiovascular fellowship or participation in a formal vascular medicine rotation during a sports medicine or orthopedic fellowship. Furthermore, American College of Cardiology Core Cardiovascular Training Statement 4 recognizes the importance of vascular medicine training during a cardiovascular fellowship (2).
Similar to sports cardiology, future opportunities in vascular sports medicine are plentiful. These opportunities include: 1) providing expertise in several vascular disorders commonly found in athletes; 2) providing better strategies to identify and care for athletes with vascular disease that may be otherwise overlooked; 3) increasing vascular medicine education through increased training programs; 4) developing of societal (e.g., vascular medicine, sports medicine, vascular surgery, orthopedics, cardiology, venous forums, and so forth) guidelines and scientific statements related to vascular sports medicine; and 5) collaborating in research endeavors. These vascular medicine services will provide integrated expertise to facilitate prevention, early detection, and institutionalization of treatment modalities to exercising individuals of all ages with vascular conditions beyond sports cardiology.
Please note: Dr. Cohoon has reported that he has no relationships relevant to the contents of this paper to disclose.
- 2017 American College of Cardiology Foundation