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Cardiovascular risk profile in Olympic athletes: an unexpected and underestimated risk scenario
  1. Flavio D’Ascenzi1,
  2. Stefano Caselli2,
  3. Federico Alvino1,
  4. Barbara Digiacinto2,
  5. Erika Lemme2,
  6. Massimo Piepoli3,
  7. Antonio Pelliccia2
  1. 1 Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
  2. 2 Institute of Sports Medicine and Science, Rome, Italy
  3. 3 Heart Failure Unit, Cardiology, G da Saliceto Hospital, Piacenza, Italy
  1. Correspondence to Dr Flavio D’Ascenzi, Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena 53100, Italy; flavio.dascenzi{at}


Background Prevalence of cardiovascular (CV) risk factors has been poorly explored in subjects regularly engaged in high-intensity exercise programmes. Our aim was, therefore, to assess the prevalence and distribution of CV risk factors in a large population of competitive athletes, to derive the characteristics of athlete’s lifestyle associated with the best CV profile.

Methods 1058 Olympic athletes (656 males, 402 females), consecutively evaluated in the period 2014–2016, represent the study population. Prevalence and distribution of CV risk factors was assessed, in relation to age, body size and sport.

Findings Dyslipidemia was the most common risk (32%), followed by increased waist circumference (25%), positive family history (18%), smoking habit (8%), hypertension (3.8%) and hyperglycaemia (0.3%). Large subset of athletes (418, 40%) had none or 1 (414, 39%) risk factor, while only a few (39, 3.7%) had 3/4 CV risk factors. The group without risks largely comprised endurance athletes (34%). Ageing was associated with higher total and low-density lipoprotein cholesterol, triglycerides (p<0.001) and glycaemia (p=0.002) and lower high-density lipoprotein cholesterol. On multivariate logistic regression analysis, age, BMI and body fat were identified as independent predictors of increased CV risk.

Interpretation Dyslipidemia and increased waist circumference are common in elite athletes (32% and 25%, respectively). A large proportion (40%) of athletes, mostly endurance, are totally free from risk factors. Only a minority (3%) presents a high CV risk, largely expression of lifestyle and related to modifiable CV risk factors.

  • physical activity
  • training
  • athlete’s heart
  • cardiovascular
  • risk factor
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  • Contributors The authors declared no conflicts of interest.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Local Ethics Committee of the Institute of Sports Medicine.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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