OBJECTIVES: The goal of this study was to determine the impact of race on 
identification of hypertrophic cardiomyopathy (HCM).
BACKGROUND: Sudden death in young competitive athletes is due to a variety of 
cardiovascular diseases (CVDs) and, most commonly, HCM. These catastrophes have 
become an important issue for African Americans, although HCM has been 
previously regarded as rare in this segment of the U.S. population.
METHODS: We studied the relationship of race to the prevalence of CVDs causing 
sudden death in our national athlete registry, and compared these findings with 
a representative multicenter hospital-based cohort of patients with HCM.
RESULTS: Of 584 athlete deaths, 286 were documented to be due to CVD at ages 17 
+/- 3 years; 156 (55%) were white, and 120 (42%) were African American. Most 
were male (90%), and 67% participated in basketball and football. Among the 286 
cardiovascular deaths, most were due to HCM (n = 102; 36%) or anomalous coronary 
artery of wrong sinus origin (n = 37; 13%). Of the athletes who died of HCM, 42 
(41%) were white, but 56 (55%) were African American. In contrast, of 1,986 
clinically identified HCM patients, only 158 (8%) were African American (p < 
0.001).
CONCLUSIONS: In this autopsy series, HCM represented a common cause of sudden 
death in young and previously undiagnosed African American male athletes, in 
sharp contrast with the infrequent clinical identification of HCM in a 
hospital-based population (i.e., by seven-fold). This discrepancy suggests that 
many HCM cases go unrecognized in the African American community, underscoring 
the need for enhanced clinical recognition of HCM to create the opportunity for 
preventive measures to be employed in high-risk patients with this complex 
disease.