Ancestry plays a major role in serious cardiac risk among Black soccer players in England, according to new research that suggests treating Black people as a homogeneous group may be misleading.

Researchers hope this could be one more tool in understanding cardiac risk among soccer players, particularly Black men. Cardiac arrest is fairly rare among athletes, but athletic organizations in England and elsewhere regularly screen for cardiovascular risk.

In the observational study, presented at the European Society of Cardiology Preventive Cardiology (EAPC) Congress 2026, researchers examined men in the English Football Association screening program.

Presenter Kentaro Yamagata, MD, MRCP, of the Institute of Sport at Manchester Metropolitan University in Manchester, England, noted that prior studies have largely treated Black athletes as a single group despite substantial heterogeneity.

This study aimed to identify which subgroups may be at the highest risk and to link ancestry not only to ECG patterns but also to clinically significant disease.

Study Methodology

Researchers evaluated 9024 male soccer players aged 16 or older — a typically healthy, elite population. Of this group, 25.4% were Black and 74.6% were not.

Screening included a health questionnaire, a 12-lead ECG, and echocardiography. T-wave inversion (TWI), an ECG marker that can indicate underlying cardiac disease, was assessed using International Criteria, with findings adjudicated by cardiologists.

Players were classified by regional ancestry using the United Nations geoscheme. Within the Black cohort, the largest subgroup was West African (51.9%), followed by Caribbean (32.0%), East African (7.1%), Central African (4.3%), North African (2.7%), and South African (2.0%).

Disease Burden Differs by Ancestry

West Africans had the highest burden of serious disease, including the highest left ventricular mass and wall thickness. Central African players had the highest prevalence of abnormal TWI at 10.1%, whereas North African players showed patterns similar to non-Black players.

Overall, Black players showed a higher prevalence of serious cardiac conditions (1.0% vs 0.4%; P = .001). Abnormal TWI was also more common in Black players, with the highest prevalence seen in Central African (10.1%) and West African (6.4%) athletes, compared with 1.6% in North African and 2.2% in non-Black athletes.

Within the Black cohort, major cardiac conditions occurred most often in players of West African origin (1.6%), followed by those of Caribbean origin (0.7%).

Neel Chokshi, MD, MBA, who was not involved in the study, believes the significance of the findings is not yet clear.

“Specifically, it is not clear that these are truly ‘abnormal’ findings, or possibly normal variants for this group and, importantly, whether these ECG findings are linked to future cardiac events,” said Choksi, director of the Center for Digital Cardiology and medical director of the Sports Cardiology and Fitness Program at the Penn Heart and Vascular Center in Philadelphia.

Future studies could focus on nuanced ECG signals and their correlation with imaging and genetic testing to help improve the sensitivity and specificity of screening protocols, said Choksi, who is also an associate professor at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia.

“Understanding the prevalence of these ECG findings in larger and ancestrally diverse populations would also help shed light on this issue,” he said.

The Future of Ancestry-Informed Screening

Professor Aneil Malhotra, PhD, MA, MRCP, MSc, a cardiologist at the Institute of Sport at Manchester Metropolitan University in Manchester, England, and a study author, hopes these findings reinforce the importance of recognizing diversity in cardiac health, particularly among Black athletes.

“Our findings do not support changing screening thresholds or introducing earlier screening purely on the basis of ancestral origin,” he said. “What the data do indicate is that clinicians should recognize that cardiac adaptation in athletes of Black ethnicity is heterogeneous.”

Malhotra and Choksi reported no relevant financial relationships.

Lois Anzelowitz Levine is a lifestyle and medical editor in Dallas.