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Review
. 2021 Nov-Dec;13(6):622-629.
doi: 10.1177/19417381211004877. Epub 2021 Mar 18.

Cardiovascular Risk Assessment in the Older Athlete

Alec J Moorman  1 , Larry S Dean  1 , Eugene Yang  1 , Jonathan A Drezner  2
Affiliations
Review

Cardiovascular Risk Assessment in the Older Athlete

Alec J Moorman et al. Sports Health. 2021 Nov-Dec.

Abstract

Context: Limited data are available to guide cardiovascular screening in adult or masters athletes (≥35 years old). This review provides recommendations and the rationale for the cardiovascular risk assessment of older athletes.

Evidence acquisition: Review of available clinical guidelines, original investigations, and additional searches across PubMed for articles relevant to cardiovascular screening, risk assessment, and prevention in adult athletes (1990-2020).

Study design: Clinical review.

Level of evidence: Level 3.

Results: Atherosclerotic coronary artery disease (CAD) is the leading cause of exercise-induced acute coronary syndromes, myocardial infarction, and sudden cardiac death in older athletes. Approximately 50% of adult patients who experience acute coronary syndromes and sudden cardiac arrest do not have prodromal symptoms of myocardial ischemia. The risk of atherosclerotic cardiovascular disease (ASCVD) can be estimated by using existing risk calculators. ASCVD 10-year risk is stratified into 3 categories: low-risk (≤10%), intermediate-risk (between 10% and 20%), and high-risk (≥20%). Coronary artery calcium (CAC) scoring with noncontrast computed tomography provides a noninvasive measure of subclinical CAD. Evidence supports a significant association between elevated CAC and the risk of future cardiovascular events, independent of traditional risk factors or symptoms. Statin therapy is recommended for primary prevention if 10-year ASCVD risk is ≥10% (intermediate- or high-risk patients) or if the Agatston score is >100 or >75th percentile for age and sex. Routine stress testing in asymptomatic, low-risk patients is not recommended.

Conclusion: We propose a comprehensive risk assessment for older athletes that combines conventional and novel risk factors for ASCVD, a 12-lead resting electrocardiogram, and a CAC score. Available risk calculators provide a 10-year estimate of ASCVD risk allowing for risk stratification and targeted management strategies. CAC scoring can refine risk estimates to improve the selection of patients for initiation or avoidance of pharmacological therapy.

Keywords: cardiovascular disease; coronary artery disease; prevention.

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Conflict of interest statement

The following author declared potential conflicts of interest: E.Y. received grants from Amgen.

Figures

Figure 1.
Figure 1.
Cardiovascular wellness and prevention program. ACC, American College of Cardiology; ASCVD, atherosclerotic cardiovascular disease; Astro-CHARM, Astronaut Cardiovascular Health and Risk Modification; BP, blood pressure; CACS, coronary artery calcium score; CHD, coronary heart disease; CRP, C-reactive protein; CT, computed tomography; ECG, electrocardiogram; FamHx, family history; HgbA1C, hemoglobin A1C; hsCRP, high-sensitivity C-reactive protein; Lp(a), lipoprotein(a); MESA, Multi-Ethnic Study of Atherosclerosis. http://tools.acc.org/ASCVD-Risk-Estimator-Plus/#!/calculate/estimate/ https://www.mesa-nhlbi.org/MESACHDRisk/MesaRiskScore/RiskScore.aspx http://astrocharm.org/calculator-working/
See this image and copyright information in PMC

References

    1. Aengevaeren VL, Mosterd A, Braber TL, et al.. Relationship between lifelong exercise volume and coronary atherosclerosis in athletes. Circulation. 2017;136:138-148. - PubMed
    1. Albert CM, Mittleman MA, Chae CU, Lee IM, Hennekens CH, Manson JE. Triggering of sudden death from cardiac causes by vigorous exertion. N Engl J Med. 2000;343:1355-1361. - PubMed
    1. American Academy of Family Physicians, American Academy of Pediatrics, American College of Sports Medicine, et al. Preparticipation Physical Evaluation. 4th ed. American Academy of Pediatrics; 2010.
    1. Arnett DK, Blumenthal RS, Albert MA, et al.. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2019;74:1376-1414. - PMC - PubMed
    1. ASCEND Study Collaborative Group, Bowman L, Mafham M, et al.. Effects of aspirin for primary prevention in persons with diabetes mellitus. N Engl J Med. 2018;379:1529-1539. - PubMed