Clockwise from left: Moses Malone, Darryl Dawkins and Caldwell Jones.

Earl Cureton knew exactly where he could find his friend Moses Malone during a recent Sixers reunion in Las Vegas. The 1983 team spent three days celebrating the 30-year reunion of their NBA title, and Malone had settled into a routine familiar to anyone who kept in touch with him since his playing days.

At night over long dinners, he told some of the funniest jokes at the table. Cureton, a former center, couldn’t remember laughing harder. Then, Malone followed up the show by beating everyone to the hotel health center in the morning. Cureton would arrive at an hour when many Vegas visitors were returning from long nights out, and Malone would already be there, mid-sweat.   

“Moses,” Cureton says, “always took good care of himself.”

Yet Malone, 60, was found dead in a Norfolk, Va., hotel room Sept. 13. The news came weeks after the late-August death of former Sixer Darryl Dawkins, 58. And Last September, former Sixer Caldwell Jones, 64, died. These players, cornerstone big men for the Sixers in the late 70s and early-to-mid 80s, all died from heart attacks.

Their deaths add to a list of some 50 other NBA players who have succumbed to complications from heart disease since 2000, a rate that may be higher than the general population. This year has been particularly eye-opening, with the deaths of well-known players Malone, Dawkins, former Laker Jack Haley, 51, and former Knick Anthony Mason, 48. The NBA’s all-time leading scorer, Kareem Abdul-Jabbar, also underwent quadruple-bypass heart surgery in April. The issue has caught the attention of NBA player unions.

“To us, it’s noticeable,” says Scott Rochelle, vice president and general counsel of the NBA Retired Players Association. “It’s noticeable enough for us to make this a priority.”

Rochelle says the Retired Players Association as recently as last week has communicated with the NBA and the National Basketball Players Association (NBPA) about bolstering efforts to provide more screening for heart complications and raise awareness among former players. The talks have been going on for months. Kim Harmon, a sports medicine and family medicine doctor at the University of Washington and a member of the NBPA’s medical advisory board, says the league will soon offer more comprehensive health screenings for retired players, including for heart issues.

Doctors will collect and analyze the data from those heart tests and see whether anything separates the former NBA players from the general population. They will attempt to find out if there are common reasons for why Malone and dozens of others’ bodies are failing not long after their basketball careers end.

“This is a trip,” says John Salley, a former 12-year NBA vet, reflecting on five former NBA players who have died this year. “Four of the five are heart disease. Moses being the oldest at 60. That’s what I’m telling guys….They have no idea.”

A higher rate than average?

No one has publicly studied possible links between former or current professional basketball players and heart disease, but anecdotal evidence suggests they may be dying from the no. 1 killer of Americans at a higher rate than average men.   

Since 2000, according to information compiled by Billy Penn from various media reports and a database on player deaths from the Association for Professional Basketball Research, at least 53 retired NBA players have died from heart disease. Thirty-three have been under age 70.

There are an estimated 1,500 living, retired NBA players. Assuming that number has remained constant since 2000, the rate of heart disease deaths for the retired NBA player population during this time frame would be about 224 deaths per 100,000. That number is slightly higher than the American male overall average of about 214 deaths per 100,000 and much higher than the American male average for coronary heart disease, which is about 156 deaths per 100,000. Coronary heart disease is the most prevalent subset of heart disease, the kind where plaque builds in arteries and leads to blockage. All but a few of these 53 retired NBA players’ deaths appear to have been from complications associated with coronary heart disease.

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The retired NBA players could be dying from heart disease for any number of reasons, from hereditary factors (hypertension and other risk factors are more common among blacks, who comprise about three-fourths of the NBA) to undiagnosed conditions to unhealthy, sedentary lifestyles.

Sixteen players in the group that have died under age 70 are 6 foot 8 inches or taller, and the others are taller than average American men — but height does not correlate with an increased risk of heart disease. The opposite might even be true. A 2010 review of 52 previous studies found that shorter people faced a significantly greater risk of having deadly cardiovascular disease than taller people (studies have shown that taller people face increased risks for other problems, such as cancer and blood clotting).

If retired NBA players are indeed dying from heart disease at a rate higher than most men, it’s possible people disposed to heart disease from common risk factors are playing the sport and experiencing problems after retirement. No evidence yet shows that the opposite – a long career in basketball correlating with heart disease – could be true.

“It’s hard to theorize that it would be basketball itself,” says Jolie Holschen, a cardiologist and professor at Loyola University Chicago who has worked with numerous athletes at college and Olympic levels.  

Every doctor will say physical activities like basketball reduce the risk of heart problems. But there could be a limit. The controversial question of whether too much exercise elevates risk has started heating up. A recent study of ultramarathon runners has shown excessive endurance running can cause heart scarring, leading to possible heart failure and heart attacks. These top-level athletes had trained harder and for longer distances than typical recreational runners.

Could the same be true for NBA athletes, who push their bodies for 10 to 15 years at a high level? Harmon doubts it, at least not for the same reasons the runners might experience problems. She says basketball’s bursts of action followed by rest make it different than the prolonged, constant nature of endurance running.   

Basketball has been a mysterious sport relating to another type of heart issue, however. Harmon and other doctors from the University of Washington found in a study that Division I basketball players suffered sudden cardiac arrest deaths — when the heart stops, as happened to Philly legend Hank Gathers — at a rate significantly higher than other college athletes from 2004 to 2008. Similarly higher rates affect high school basketball players, too. Doctors have even seen young athletes like football players suffer sudden cardiac arrest while playing basketball.

“It appears there’s something about the nature of the sport that has hardened the heart in certain people,” Harmon says. “It remains a bit of a mystery. Certainly, it’s something that we’re seeing again and again.”

But those athletes are young and experiencing a mostly different type of heart trauma while playing the sport. Whether certain characteristics stand out among older, former basketball players and their battles with heart disease is something the NBA, NBPA and NBA Retired Players Association will hope to find out.

The pounding NBA players take

The steps for detecting or preventing possible heart problems are well known. Get an electrocardiogram, echocardiogram or stress test and have routine physicals. Eat healthy. Exercise often. That last part can prove difficult for retired NBA players and not just because they face the usual barriers to exercise, like work and family obligations.

Cureton works out every morning, walking up to four miles or using the elliptical. He also lifts weights three days per week. But he doesn’t run. He can’t. Cureton had hip replacement surgery shortly after his career ended. Other former NBA players he remains close to in his hometown of Detroit, like Rick Mahorn and John Long, deal with similar problems.

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Jim McIlvaine, a 7-1 center who played for three NBA teams from 1994 to 2001, remembers a discussion from early in his career with former player Joel Wolf, talking about how he needed hip surgery even though he never had any serious injuries. It was the constant running and jumping and banging around in the paint that added up. Be it backs, knees or hips, most everyone who’s played in the NBA for some amount of time is likely dealing with pain that makes strenuous activities difficult later in life.  

“They find themselves in a position where they can’t exercise because it hurts too much,” McIlvaine says. “One guy told me he was on a regular anti-inflammatory regimen and he went off of them and could hardly get out of bed the next morning.”

The heart attack death of Yinka Dare, 31, in 2004 first made McIlvaine think about heart problems for NBA players, particularly big men like himself. Haley’s and Malone’s deaths provided stark reminders. He had recently seen both at Retired Players Association functions and wrote blog posts after their deaths: “There is a lot of deserved talk about the early death of many NFL players, but perhaps there should also be some concern raised about the reasons why so many former NBA players are dying so young and if anything can be done to prevent that.”

Salley, who is now a wellness advocate, would like the NBA to better promote healthy habits for players when they’re in the league (and wouldn’t mind a gig speaking to players himself). He learned nutrition from Adrian Dantley his rookie year with the Pistons and eventually became a vegetarian and finally a vegan. A couple of heart palpitations during Salley’s career scared him into taking nutrition seriously.      

“I’d always known that my heart could have any kind of problems,” he says. “So then I realized you know what, I’m going to have to take care of this heart and pay attention to everything I’m putting inside of it.”

Salley never felt like he could escape the health risks everyone faces. That’s not the case with many NBA players, admits McIlvaine. They’ve long been used to “a feeling of invincibility” during their careers and don’t easily lose it. Some of those who have died from heart problems, like Kevin Duckworth and Robert “Tractor” Traylor had battled with weight. Malone, Jones, Dawkins and many others appeared to be in good shape.

“It’s maybe deceptive and that’s maybe part of the problem,” McIlvaine says. “We may look healthy but in reality we’re certainly not as healthy as we were when playing — and maybe not the picture of health that we appear to be.”   

Too early for Malone, Jones and Dawkins

Cureton last spoke with Malone about a month before his death. They talked about plans to meet up for an autograph session in November.

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He hadn’t spoken to Jones in a while and regrets it. Jones’ locker was right next to his early in his career, and he gave Cureton indispensable advice about career longevity, explaining how an NBA player could give maximum effort in games without over-exerting himself.

Cureton grew particularly close to Dawkins during their years for the Sixers. Dawkins was already famous for his backboard-shattering dunks and his playful names for them when Cureton entered the league in 1980, but his celebrity status didn’t preclude him from slumming it with Cureton at his mother’s house in Detroit following his rookie season. Cureton’s friends couldn’t believe it.

“When he passed,” he says, “I laughed and I cried because I thought about all the funny things he’s said and the fact that he was gone.”

Cureton is also cognizant that as a 6-9, 58-year-old former NBA player, he’s at the same stage of life they were. Despite his routine workouts, he says he’s still a little overweight and has trouble giving up his favorite junk foods, like potato chips.

Cureton once had a friend tell him that you don’t see too many 6-10 or seven-foot guys around who are 70, 80 years old.

“And I thought about it,” he says. “You don’t see a whole lot of guys up in that age. But 59 or 60? That’s young. I still haven’t gotten over all three of those guys being gone.”

Mark Dent is a reporter/curator at BillyPenn. He previously worked for the Pittsburgh Post-Gazette, where he covered the Jerry Sandusky scandal, Penn State football and the Penn State administration. His...