Cardiovascular risk profile in Olympic athletes: an unexpected and underestimated risk scenario

Br J Sports Med. 2019 Jan;53(1):37-42. doi: 10.1136/bjsports-2018-099530. Epub 2018 Sep 14.


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.

Keywords: athlete’s heart; cardiovascular; physical activity; risk factor; training.

MeSH terms

  • Adolescent
  • Adult
  • Athletes*
  • Cardiovascular Diseases / epidemiology*
  • Dyslipidemias / epidemiology*
  • Female
  • Humans
  • Life Style
  • Male
  • Prevalence
  • Risk Factors
  • Waist Circumference*
  • Young Adult