Research & Education

Cardiovascular Risk Among Masters Athletes

“Despite their high fitness level, masters athletes can exhibit elevated cardiovascular risk and possess CVD.” (Morrison et al, 2018)

It’s easy to assume that the people we see jogging or cycling on trails or along the road are in good health—especially cardiovascular health. After all, that’s exactly what that kind of exercise is typically recommended for: improving or maintaining cardiovascular fitness. However, stories abound of marathoners having sudden heart attacks, and even professional athletes aren’t immune to chronic disease. The verdict long since came back that physical activity is beneficial for several aspects of physical and mental/emotional wellbeing, but that doesn’t mean it’s a never-fail panacea. A recent study from Canada regarding cardiovascular disease (CVD) among masters athletes makes exercise’s halo seem just a little less shiny.  

The study included nearly 800 masters athletes. Participants were predominately male (62.7%) and Caucasian (87.7%), with a mean age of 54.6 years (range 35–81). Subjects participated in 23 sports, but the most common primary sports (many participated in more than one sport) were running (34.2%), cycling (19.1%), hockey (10.9%), triathlon (9.5%) and rowing (4.3%). Over half of the participants had completed a half or full marathon, and several had completed multiple marathons.

Among these subjects, 11.4% were found to have previously undetected cardiovascular disease, with coronary artery disease (CAD) being the most common diagnosis (7.9% of subjects). Ten athletes were diagnosed with “significant CAD,” yet most of them were asymptomatic. This is reflective of other findings the researchers noted, such as coronary artery disease being the primary cause of sudden cardiac death in athletes over 35 years old, yet as many as 88% of cases have no symptoms or advance warning signs. The researchers wrote, “Masters athletes are not immune to elevated cardiovascular risk and cardiovascular disease.”

Compared to the general Canadian population, the study population had a substantially lower prevalence of obesity, diabetes, dyslipidemia and depression, with prevalence of hypertension being nearly the same, and heavy drinking among the study population being slightly higher.

A question that comes to mind quickly is, were these new athletes? That is, were the study participants identified to have CVD new to exercise? If so, that would imply that their previous lifestyle may have been a factor in the development of CVD. Well, according to the study, participants had already been active for 35.1±14.8 years, and time spent in moderate to vigorous physical activity was 7.6±4.3 hours per week. So, no, these weren’t novices, and they were active for several hours a week. Not exactly couch potatoes suddenly turned weekend warriors. These were seasoned exercise veterans. And yet, some had unrecognized CVD.

To be fair, 11.4% of subjects having CVD is still a small proportion, so this isn’t completely shocking. What is surprising, though, is that only 27% of the people diagnosed with CAD had reported symptoms. None of the participants found to have obstructive CAD reported angina, but four with non-obstructive disease reported angina. These kinds of findings underlie the fact that sometimes, the first sign of cardiovascular disease is death from a heart attack.

Other researchers have noted that exercise can’t always counteract other aspects of life that may contribute to chronic disease—not just CVD, but type 2 diabetes, metabolic syndrome, and more. Tim Noakes, a South African professor of exercise science and legend in the running community, developed type 2 diabetes despite a heavy running load. He has since gone on to be a leading voice in the use of low carbohydrate diets to manage and reverse metabolic illness, including among athletes. He was co-author of a paper with the telling title, It is time to bust the myth of physical inactivity and obesity: you cannot outrun a bad diet.

Too much exercise, too intensely, too often, may not be quite as detrimental as being completely sedentary, but it comes with risks of its own. Cardiologist James O’Keefe delivered a TEDx talk in which he discussed reasonable and beneficial amounts of exercise, and compared them to what happens when people take things too far. As with water and oxygen, the dose makes the poison: too little is bad, but that doesn’t always mean more is better.

And while many people laugh at the advice, it’s not a bad idea to do what they say at the end of commercials for exercise equipment: people should check with their doctors to see if they’re healthy enough for exercise. Or if they’ve been exercising for a while, they shouldn’t automatically assume their heart and blood vessels are in tip-top shape.

By Amy Berger, MS, CNS