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. 2021 Mar 18;13(6):622–629. doi: 10.1177/19417381211004877

Table 2.

Key points in the cardiovascular risk assessment and management of older athletes

• In adult athletes ≥35 years old, CAD is the primary cause of major adverse cardiovascular events.
• A CAC scan quantifies the burden of calcified atherosclerotic plaque and provides important prognostic value.
• A comprehensive risk assessment for CVD in older athletes includes a review of conventional risk markers, physical examination, 12-lead ECG, and CAC score.
• 10-year risk of ASCVD should be estimated for adult athletes using a validated risk calculator such as the ACC/AHA, Astro-CHARM, or MESA calculators.
• CAC scoring or risk-enhancing factors such as hsCRP and Lp(a) may be used to reclassify or revise the risk assessment.
• Studies of endurance athletes not only demonstrate higher prevalence of CAC compared with nonathletes but also suggest coronary plaque composition in athletes is more stable and may not confer the same risk.
• Lifestyle interventions are recommended to optimize cardiovascular health.
• Blood pressure should be optimally controlled to reduce CVD risk.
• Statin therapy is recommended if 10-year risk of ASCVD is ≥10% and considered if risk is ≥7.5%.
• Low-dose aspirin 75-100 mg daily can be considered for athletes with high ASCVD risk and low bleeding risk.
• Stress testing is recommended for athletes with symptoms concerning for ischemic heart disease.
• Stress testing may be considered for asymptomatic athletes with high ASCVD risk (eg, markedly elevated CAC score ≥400).
• Echocardiography or cardiac MRI is recommended for athletes with physical examination or ECG abnormalities concerning for valvular heart disease or cardiomyopathy.

ACC/AHA, American College of Cardiology/American Heart Association; ASCVD, atherosclerotic cardiovascular disease; Astro-CHARM, Astronaut Cardiovascular Health and Risk Modification; CAC, coronary artery calcium; CAD, coronary artery disease; CVD, cardiovascular disease; ECG, electrocardiogram; hsCRP, high-sensitivity C-reactive protein; Lp(a), lipoprotein(a); MESA, Multi-Ethnic Study of Atherosclerosis; MRI, magnetic resonance imaging.