Lessons in CVD Prevention From Jackie Robinson

Jackie Robinson was the first Black person to play Major League Baseball, making his debut in the spring of 1947 with the Brooklyn Dodgers at 28 years of age. Wearing number 42, Robinson broke the color barrier in America's cherished pastime sport. Robinson would go on to win the league's Most Valuable Player award only 2 years later, leading in batting average and stolen bases. In addition to playing professional baseball, Jackie Robinson was a champion for civil rights and a pioneer in human dignity, consistently persevering through challenges of racial discrimination both on and off the field. Whereas these memories are the often-remembered tales of Robinson and his associated fame, examining untold stories, including his place of birth and his post-baseball cardiometabolic health, may help us more deeply understand ongoing modern-day atherosclerotic cardiovascular disease (ASCVD) inequities, as well as opportunities to develop prevention strategies.

Robinson was born to a family of sharecroppers in Cairo, GA. He experienced a challenging youth in a single-parent household; his mother, Mallie, cared for him and his 4 siblings. Robinson's hometown of Cairo, a rural town with a diverse ethnic composition, includes a considerable prevalence of Black (46%), White (33%), and Hispanic (18%) people. The rural and southern sections of the United States are disproportionately affected by disparities that adversely affect cardiovascular health; there is a large difference in the age-adjusted ASCVD mortality rate (43 per 10 000) in rural compared with metropolitan areas,^[1] whereas the South has the highest burden of disability-adjusted life-years due to ASCVD.^[2] Furthermore, racism is an often-overlooked contributor to the persistent gaps in cardiovascular health. Of concern, a plaque honoring Jackie Robinson in Cairo was recently vandalized in a series of incidents across Georgia that appear to have been racially motivated. Robinson's birthplace thus symbolizes the current challenging landscape for ASCVD prevention in the United States, particularly in rural and southern areas of the country, where not all individuals have equitable access to medical care, affordable therapies, and a local environment that promotes cardiovascular health.

Despite being an all-star professional athlete and Major League Baseball's Most Valuable Player, Jackie Robinson's end of career and post-baseball life were affected by adverse cardiometabolic health and mental stress. In 1952, at 33 years of age, he was diagnosed with type 2 diabetes (T2D), and it was noted that his weight would regularly fluctuate throughout his career. Shortly after his rookie season, Robinson and friends celebrated on a trip through the southern United States, during which it was claimed that he gained 25 pounds due to poor dietary habits. He would also regularly travel back to support his home state of Georgia. On one occasion, he returned to Albany, GA, with a suitcase of money to bail out Albany State University students who had been arrested during a peaceful protest after not being allowed to sit at a lunch counter to order food.

Such accounts allude to the fact that Robinson was playing baseball with prediabetes and the burden of mental stress, 2 early and upstream risk factors for ASCVD, and that even professional athletes can benefit substantially from routine preventive care. Whereas Jackie Robinson did have access to medical care, many of his risk factors were largely untreated until the end of his career, when he started to experience complications of T2D, including progressive loss of vision, while playing baseball. Related to Robinson's case is the fact that Black adults are 60% more likely to be diagnosed with T2D and have a much higher case fatality rate (39% versus 19%) compared with White adults.^[3] Therefore, continued efforts are necessary in T2D prevention and care to reduce disease burden in Black communities.

The biology of adversity underlying the potential link between Robinson's mental stress and poor cardiometabolic outcomes may have included behavioral (eg, food availability), system-level (eg, racism and risk factor screening), and physiological (eg, accelerated subclinical atherosclerosis) pathways.^[4] Overall, the social determinants of health related to Jackie Robinson's hometown in the rural South and the mental stress burden of battling racial tensions throughout his career should not be overlooked in the interpretation of his cardiometabolic risk across his life span.

A significant ASCVD risk factor burden, including T2D and obesity, would unfortunately contribute to Robinson's early passing in 1972 at 53 years of age due to sudden cardiac death. T2D is a strong risk factor for sudden cardiac death; it is an important contributor to ischemic heart disease, which contributes to up to 80% of all sudden cardiac deaths. The comprehensive management of ASCVD risk factors among those with T2D is critical to the prevention of sudden cardiac death.^[5] Robinson's death could have been delayed, even prevented, with appropriate approaches to lifestyle and pharmacotherapies, in addition to resilience strategies geared toward mitigating mental stress and racial discrimination.

In today's medicine and sports era, athletes have more often been open to acknowledging their health concerns to help affect the general public in places such as Cairo. However, previous stories related to cardiovascular health went unnoticed or remained largely untold, as in the case of Jackie Robinson. The untold Jackie Robinson story specifically illustrates that no person is immune to the development of ASCVD risk factors and their sequelae but also demonstrates the potential benefits of comprehensive prevention. Jackie Robinson's story sheds light on the pathophysiology of atherogenesis, as well as the ticking-clock hypothesis of long-term cardiometabolic risk.

Jackie Robinson helped to equalize the playing field for athletes of all backgrounds to participate on the main stage of Major League Baseball, and he was a vocal civil rights advocate. Robinson's well-known story is important to share; however, Robinson's untold story of premature ASCVD may be just as important, as it emphasizes that the preventive cardiology playing field continues to be inequitable throughout communities across the United States. As stated by native Atlantan Dr Martin Luther King Jr, "What affects one of us affects all of us." We hope that reviewing Jackie Robinson's largely untold social and medical history can help to inspire a new field of dreams in the quest of reducing preventable ASCVD burden and mortality for all.