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Impact of sporting discipline, gender, ethnicity, and genetics on the athlete’s heart

Participation in regular exercise is associated with several electrical and structural cardiac adaptations collectively termed the ‘athlete’s heart’. The nature and extent of these changes are influenced by several demographic factors, including the sporting discipline, gender, and ethnicity of the athlete. Knowledge of these influences is crucial for the correct interpretation of data from pre-participation cardiac evaluation of athletes and prevention of erroneous diagnoses. The greatest adaptations are usually observed in male athletes, those competing in endurance exercise, and those of African/Afro-Caribbean (black) ethnicity. In particular, much attention has recently been given to cardiac remodelling in black athletes, a significant proportion of whom exhibit profound electrical and structural cardiac changes in response to exercise. Data on the influence of genetic factors on the athlete’s heart are now emerging, which may aid our understanding of the complex mechanisms underlying this process and ultimately help differentiation of normal physiology from cardiac pathology.