O1019: Vitamin D Status and Cardiovascular Disease in Collegiate Athletes with Acute sars-cov-2 Infection

Background: Vitamin D is crucial to human health and low vitamin D (LVD) is common in athletes. Optimal vitamin D status may reduce the risk and severity of SARS-CoV-2 infection. COVID-19, the disease caused by SARS-CoV-2, directly affects the cardiovascular (CV) system, leading to myocarditis, pericarditis, heart failure, arrythmias, acute coronary syndromes, thromboembolism or death. Indeed, recent studies of athletes with COVID-19 report a prevalence of myocarditis as high as 3.0%. The connection between vitamin D status and CV disease, particularly myocarditis, in athletes following COVID-19 is unknown but clinically relevant as myocarditis accounts for 3-8% of sudden cardiac arrest in athletes. The purpose of this study is to evaluate the association between vitamin D status and the presence of CV disease after COVID-19 in collegiate athletes.

Methods: This was a retrospective cohort study of varsity athletes at our institution enrolled during the 2020-2021 and/or 2021-2022 academic cycles who had a positive SARS-CoV-2 polymerase chain reaction test, had cardiac magnetic resonance (CMR) and vitamin D (25-hydroxyvitamin D) level measurements. Our institution’s return to play criteria included electrocardiogram, troponin-I, echocardiogram and CMR in all athletes with COVID-19. LVD was defined as a level < 30 ng/mL. CMR measurements included volumetrics, ventricular function, parametric mapping, extracellular volume (ECV), global circumferential strain (GCS), and late gadolinium enhancement. Myocarditis was defined by the modified Lake Louise Criteria. Mann–Whitney U (continuous variables) and Chi-Square tests (categorical variables) were used to determine if there was a significant difference in age, sex, race, ethnicity and CMR between athletes with LVD and normal vitamin D status. Multivariate linear regression was used to assess the relationship between LVD and CMR metrics while accounting for differences in age and sex.

Results: 157 COVID-19-positive athletes (97 male, 60 female; mean age: 20 years-old) from 9 sports were included (Table 1). 21.0% (33) of athletes had LVD. In athletes with LVD, 12.1% (4) were female. In athletes with normal vitamin D status, 45.2% (56) were female. Black athletes were more likely to have LVD than Caucasian athletes (p < 0.001). There was no difference based on ethnicity. Increased biventricular volumes and lower mid-ventricular ECV were noted for athletes with LVD, but these differences were no longer significant when corrected for age and sex (Table 2). Subtle differences in GCS between athletes with and without LVD were noted and are likely clinically insignificant. Vitamin D status did not associate with myocarditis and/or pericarditis (p=0.65).

Conclusion: This study demonstrated that LVD is common, particularly in Black male athletes. Cardiac structure, function, and tissue characterization did not differ by vitamin D status, though the study was underpowered to detect a difference in risk of myocarditis and/or pericarditis due to the low event rates.