November 3, 2010
For N.F.L. Players, Another Risk: Heart Disease
By HARVEY ARATON

PHILADELPHIA — Eighteen years after his last football game, Brad Quast has a stack of medical records describing the devastating effects of a brief career of very hard knocks: badly injured knees, the remnants of a serious neck injury sustained while playing in college and enough concussive damage to have caused short-term memory loss.

But his physiological reality did not truly hit home until the day his 14-year-old son wavered on playing high school football and made his father the basis of his apprehension.

“I used to play some basketball and try to walk around the golf course,” Quast said. “Zach saw me deteriorate. He said, ‘Dad, you can’t run anymore.’ ”

Not good, they both knew, for a once superfit man who is only 42.

A star linebacker at Iowa, Quast was the Jets’ 10th-round draft pick in 1990 but was released that year without playing a game. After a stint with Barcelona in the World League of American Football, which is now defunct, he signed a two-year contract with the Philadelphia Eagles in 1992, tore up his knee in a preseason game and never played again.

Injured or inactive the entire time he was affiliated with the N.F.L., Quast did not qualify for a league pension, but he did require several operations that have sheared his knees of cartilage — “bone on bone,” he said. He cannot run, but Quast signed up quickly for a free cardiovascular screening for retired N.F.L. players in late September at the Perelman Center for Advanced Medicine at the Hospital of the University of Pennsylvania near his home in southern New Jersey.

“I don’t want to be one of those guys you pick up the paper and read about,” he said, referring to news reports of young former professional football players dying of heart attacks.

Quast was shaken in 2004 when the Hall of Fame defensive end Reggie White, whom he got to know with the Eagles, died of cardiac arrhythmia at 43. “He was larger than life,” Quast said. “When that happens to a guy like him, it makes you wonder if we’re all a piece of meat.”

The cardiovascular screening program for retired N.F.L. players was created in 2003 by a retired New Jersey heart surgeon, Dr. Arthur Roberts, and was originally financed by the players union and private donations. The program has since expanded and moved under an umbrella group called the N.F.L. Player Care Foundation, which includes the union, the league, a player alumni group and the Pro Football Hall of Fame.

Roberts, a star quarterback at Columbia in the 1960s known as Archie, said the issue of concussions in football had overshadowed the risk of heart disease to retired players.

“The danger of concussions has exploded as a national issue because it has such a powerful effect on society,” Roberts said. “Our kids play sports and suffer concussions, not just gladiators playing professional football. But the reality is that cardiovascular disease is the leading killer of men.”

Since May, Norman Hand, who played 10 N.F.L. seasons as a 300-plus-pound defensive tackle, has died of heart disease at 37; Harry Galbreath, a nine-year N.F.L. guard, has died of a heart attack at 45; and Jack Tatum, who had diabetes, has died of heart failure at 61.

There have been other deaths of retired players this year and in past years, occasionally coming in flurries.

Although some studies have shown retired N.F.L. players to have higher rates of indicators for cardiovascular disease like hypertension and artery-clogging plaque, experts say no hard data suggest that N.F.L. players over all are at greater risk of dying younger of heart disease than men of corresponding size and health in the general population. But most football players are recognizable names, especially to one another, and each death can heighten their fear.

“It’s all very scary to read about these guys,” said Mike Quick, 51, a standout receiver for Philadelphia from 1982 to 1990, who was one of 45 former players screened in September. A broadcaster for the Eagles, Quick arrived early for the Saturday morning screening and later rushed to catch a flight to Jacksonville, Fla., where Philadelphia played the next day.

“The things we put our bodies through, they just aren’t meant to do,” said Quick, who learned of the free screenings through the union.

As an African-American, Quick worries because general-population studies have shown higher risk of heart disease for black men, although most experts studying heart disease in football say the drastic increase in linemen’s weight poses the gravest health threat.

Dr. Sherry Baron, the coordinator for priority populations and health disparities at the National Institute for Occupational Safety and Health, is updating her 1994 study that showed clear disparities across field positions. In a telephone interview, she said it was logical to assume that the size and speed of 21st-century players, believed to have created a more violent game that has intensified the neurological debate, have also elevated the dangers of cardiovascular disease by increasing the risk of debilitating injury that can limit postcareer activity, as in Quast’s case.

But an examination of 201 player screenings from Roberts’s program in 2006 and 2007 by Dr. R. Todd Hurst of the Mayo Clinic in Scottsdale, Ariz., found ailments in retired players of all sizes that harden arteries and can increase the risk of stroke and death by up to four times. That puts them in the same risk category as obese, nonathletic men.

Hurst added that factors including genetics, possible steroid use (which he called “the elephant in the room”) and poor dietary habits “make it a real challenge for us as scientists to figure out where these guys fit to match them with others.”

“Ultimately,” he added, “it is not playing in the N.F.L. that increases the risk; it’s what happens after they retire.”

Roberts’s team — which includes several of his relatives and medical volunteers — has worked in conjunction with one headed by Dr. Jeffrey Boone of the Boone Heart Institute in Denver to screen almost 2,000 retired players. But Roberts acknowledged that a majority of about 16,000 retirees with at least one year of N.F.L. service remained elusively at risk.

“You could make the argument that the ones who need this most are not the ones who generally show up,” he said, expressing some frustration.

Roberts spent two years on the Cleveland Browns’ taxi squad while attending medical school at Case Western Reserve. In 1967, he signed with the Miami Dolphins, then in the American Football League. In the only game of his career, he completed 5 of 11 passes in a lopsided loss to Kansas City. He quit football after that season and eventually became a heart surgeon, performing thousands of operations until he had a stroke at 58 that ended his surgeon’s career.

“The doctor wasn’t listening to the advice he was giving his patients,” Roberts said. “I neglected regular exams and follow-ups that I insisted my patients get. I wasn’t exercising, eating right. I should have known better. But when I had my stroke, it started a new phase of my life.”

He came to believe that his sense of invulnerability had much to do with his athletic past. That thought helped him hatch the idea for the nonprofit Living Heart Foundation, which he initially dedicated to fighting sudden cardiac death in high school, college and professional athletes. Soon after, he focused on N.F.L. players, active and retired, hoping to help them avoid the mistakes he had made.

“I feel as if all of these guys are a part of me,” Roberts said at the Philadelphia screening, where he played a largely supervisory role, greeting players, directing them to each station and making sure the traffic flowed freely. He was especially pleased when he recognized a player returning for a second or third screening.

A fair number of the screened players in the past were told they needed immediate care, Roberts said. He recalled at least two — one of whom he knew from his playing days — who soon had coronary bypass surgery.

“I score what we’ve done as far from perfect,” he said. “But after six years I do feel good about the effect we’ve had guiding players to procedures and helping them understand the risks. I believe we have saved some lives.”

Brad Quast, whose fringe career was not unlike Roberts’s but who finished in much worse shape, was screened for the first time after the conversation last summer with his son and with the encouragement of his wife, Cyndi, who had been worried about his health. Two years ago, when he participated in an N.F.L. study on concussions, she was home when the results arrived by mail.

“She opened them and it was, ‘Oh, God,’ ” Quast said. “Before that it was something we occasionally thought about. Now it was a medical person telling you about a lack of motor skills, short-term memory loss, fluid on the brain. They can talk about death rates not being higher, but what about the quality of life? I’ve already had to focus harder because of the memory loss, and I realized I could deal with this stuff later on or deal with it now. When I heard about the screenings, I thought this is also something I should do. Because of my knees, I think I’m at risk.”

The two-plus-hour physical included an echocardiogram, carotid artery ultrasound and blood work. The findings were given to each man’s personal physician.

During an exit interview with Dr. Lee Goldberg of the Penn Heart and Vascular Center, Quast was told that his arteries and ventricles were healthy enough. But the doctor advised him to substitute swimming for running and lectured him to avoid rich food. He also warned Quast that his weight, 248 pounds, was a little too high for his bone mass and 6-foot-1 frame.

At Iowa, Quast was all-Big Ten in 1988 and 1989. He tied a team record with a 94-yard interception return for a touchdown against Kansas State. But the injuries he sustained while trying to make the Jets and the Eagles aborted his N.F.L. dream. By 1993, he could no longer pass a physical.

“All of a sudden, you’re done at a young age — I was 25 — and you’re not the man anymore,” he said. “No one is picking up your drinks or paying for your gym. Guys’ girlfriends and wives are used to living a certain way, in a $700,000 house, and that can come to an abrupt end. Guys get scared; they get depressed.”

Several former players at the screening said the loss of an N.F.L. income could be exacerbated by the stripping of one’s athletic identity and self-worth. Depression combined with physical limitations can lead to bad eating habits, weight gain, obesity, high blood pressure and hypertension.

Kevin Guskiewicz of the Center for the Study of Retired Athletes at the University of North Carolina called this the snowball effect. His 2003 survey of 2,700 retired football players suggested links between osteoarthritis of the lower extremities and hypertension and coronary disease at rates higher than those in the general population.

To make the screening program more effective, Roberts has been advised by consulting cardiologists to focus it on those making the transition out of football to better educate them on the dangers of an unhealthy diet and failing to maintain muscle mass.

Quast earned a business degree at Iowa, easing his postfootball adjustment. He works as the director of sales for a company that provides outpatient pharmaceutical equipment. “I have a beautiful wife, three great kids and a heck of a lot to live for,“ he said.

Golf may be possible again some day, he said, with cartilage growth treatment or knee replacements, which would be covered by the Eagles in a medical settlement. He has changed a few habits, seldom eating after 6 p.m. and trying to avoid beer.

Yet with all that he has suffered and sacrificed, Quast and his family have not shunned football. His son Zach joined the high school team this fall after all. Quast helps coach a youth league in which his 10-year-old son, Shane, plays.

“So many of my buddies have steered their kids away,” he said. “But it’s out there, and it has such appeal.” He paused and added, “My wife, she’s been really good about it.”