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Subclinical coronary artery disease in veteran athletes: is a new preparticipation methodology required?
  1. Hélder Dores1,2,3,4,
  2. Pedro de Araújo Gonçalves2,3,4,
  3. José Monge1,
  4. Rogério Costa5,
  5. Luis Tátá5,
  6. Aneil Malhotra6,
  7. Sanjay Sharma6,
  8. Nuno Cardim2,3,4,
  9. Nuno Neuparth3,4
  1. 1 Cardiology, Armed Forces Hospital, Lisbon, Portugal
  2. 2 Cardiology, Luz Hospital, Lisbon, Portugal
  3. 3 NOVA Medical School, Lisbon, Portugal
  4. 4 CEDOC (Chronic Diseases Research Center), Lisbon, Portugal
  5. 5 Radiology, Armed Forces Hospital, Lisbon, Portugal
  6. 6 Cardiology Clinical Academic Group, St George’s, University of London, London, UK
  1. Correspondence to Dr Hélder Dores, Armed Forces Hospital, Lisbon 1649-020, Portugal; heldores{at}


Objective Preparticipation evaluation of veteran athletes should focus on accurate cardiovascular (CV) risk stratification and subclinical detection of coronary artery disease (CAD), which is the main cause of sudden cardiac death in this population. We aimed to investigate the effectiveness of current preparticipation methodology used to identify veteran athletes with high coronary atherosclerotic burden.

Methods A total of 105 asymptomatic male athletes aged ≥40 years old, with low to moderate CV risk (Systematic Coronary Risk Estimation <5%) who trained ≥4 hours/week for at least 5 years, were studied. The screening protocol included clinical evaluation, ECG, transthoracic echocardiogram and exercise testing. Cardiac CT was performed to detect CAD, defined as a high atherosclerotic burden according to coronary artery calcium score and coronary CT angiography.

Results The majority of the athletes (n=88) engaged in endurance sports, with a median volume of exercise of 66 (44; 103) metabolic equivalent task score/hour/week. Exercise testing was abnormal in 13 (12.4%) athletes, 6 (5.7%) with electrocardiographic criteria for myocardial ischaemia and 7 (6.7%) with exercise-induced ventricular arrhythmias. A high coronary atherosclerotic burden was present in 27 (25.7%) athletes, of whom 11 (40.7%) had CV risk factors and 6 had abnormal exercise tests, including 3 who were positive for myocardial ischaemia.

Conclusions Conventional methodology used in preparticipation evaluation of veteran athletes, based on clinical CV risk factors and exercise testing, was poor at identifying significant subclinical CAD. The inclusion of more objective markers, particularly data derived from cardiac CT, is promising for more accurate CV risk stratification of these athletes.

  • athlete
  • heart disease
  • risk factor
  • evaluation

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  • Contributors HD: conception, design, analysis, drafting, revising and final approval. PAG: design, analysis, revising and final approval. JM: design and revising. RC: acquisition and analysis. LT: acquisition and analysis. AM: analysis, revising and final approval. SS: analysis, revising and final approval. NC: conception and final approval. NN: conception and final approval.

  • 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 The study was approved by the ethics committees of NOVA Medical School and Armed Forces Hospital.

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

  • Data sharing statement No unpublished data are available from this study.