A recent JACC state-of-the-art review suggests that older athletes might face some unique cardiovascular changes, and although medical imaging can help identify their risk, the results need to be carefully interpreted.
- Masters athletes (ages 35 and up) are now a growing patient group within competitive or high-intensity exercise.
- These athletes often show cardiac changes that blur the line between sport-driven adaptations and early disease.
- Making things even more complex, cardio-intensive exercise provides CV protection but it doesn’t completely get rid of the naturally occurring risks that come with aging.
To better understand these patients, researchers looked at how physicians interpret multiple cardiac imaging modalities for masters athletes especially for changes in heart structure and how this complicates disease detection.
- For example, older athletes commonly have larger heart chambers (atria) and ventricular shapes which differ from the average patient.
- These structural changes likely start when the athlete is young and are then later influenced by aging and cardiovascular disease onset.
Looking past big changes in the heart’s shape, researchers also looked for subtle signs like…
- Myocardial fibrosis (often associated with AFib in normal patients) was common in endurance athletes and may be a positive adaptation rather than a negative one.
- Slight atherosclerosis in the form of coronary artery calcification from lifetime high-intensity exercise was also often elevated in masters athletes.
While these changes might seem alarming to some cardiologists, the study’s authors clarify that there is a big difference between the average masters athlete and an older person in the general population.
- This means that what we would typically think of as a “red flag” on a cardiac scan probably needs a second look using a patient’s athletic history as context.
- Masters athletes also differ in the way they experience heart symptoms, so things like classic angina might be less of a clue than a sudden drop in athletic performance.
It’s also important to remember that the “masters athlete” category is broad and includes everything from lifelong competitors to weekend warriors, so ultimately each heart patient deserves a tailored approach.
The Takeaway
This study is a reminder to physicians that a patient’s athletic history can vastly change the way their heart looks in cardiac images, so context is key. It’s also a reminder to the average non-athlete just how much staying active can change your heart (for the better).
