CHARACTERISTICS, RISK PROFILES AND MANAGEMENT STRATEGIES OF PREVALENT CARDIOVASCULAR DISEASE IN ATHLETIC POPULATIONS
Main Article Content
Abstract
Introduction: Cardiovascular diseases in athletes represent a complex medical issue that is receiving increasing global attention. Although regular physical training offers numerous cardiovascular benefits and reduces the risk of death from heart disease, in certain athletes with underlying cardiac conditions, high-intensity sports activities may increase the risk of sudden cardiac death. Overview: Sudden cardiac death during sports is the leading cause of mortality among athletes and has a profound psychological impact on families and the sports community. This document summarizes the latest insights into the epidemiology, pathophysiology, causes, risk factors, diagnostic approaches, and management of cardiovascular diseases in athletes, updated according to the most recent international guidelines from 2024-2025.
Keywords
Cardiovascular disease, athletes, cardiovascular screening
Article Details
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References
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36. Task Force Members, Monserrat L, Elliott PM, et al. Non-invasive prediction of sudden arrhythmic death in hypertrophic cardiomyopathy: the HCM Risk-SCD model. Eur Heart J. 2018. 39(22), 2058-2064. DOI: 10.1093/eurheartj/ehy102.
2. Mannakkara NN, Sharma S. Sudden cardiac death in athletes. Trends Urol Men's Health. 2020.11(4):10-14.
3. Petek BJ, Churchill TW, Moulson N, et al. Sudden Cardiac Death in National Collegiate Athletic Association Athletes: A 20-Year Study. Circulation. 2024. 149(2):80-90. DOI: 10.1161/CIRCULATIONAHA.123.066953
4. Harmon KG, Asif IM, Klossner D, et al. Incidence of sudden cardiac death in National Collegiate Athletic Association athletes. Circulation. 2011. 123(15),1594-1600. DOI: 10.1161/CIRCULATIONAHA.110.004622
5. Finocchiaro G, Westaby J, Sheppard MN, et al. Sudden cardiac death in young athletes: JACC state-of-the-art review. J Am Coll Cardiol. 2024. 83(2), 350-370. DOI: 10.1016/j.jacc.2023.11.006
6. Pelliccia A, Link MS, Maron BJ. Screening to prevent sudden cardiac death in competitive athletes. UpToDate. 2025.
7. Maron BJ. Structural features of the athlete heart as defined by echocardiography. J Am Coll Cardiol. 1986. 7(1),190-203. DOI: 10.1016/s0735-1097(86)80282-0
8. Sharma S, Merghani A, Mont L. Exercise and the heart: the good, the bad, and the ugly. Eur Heart J. 2015;36(23):1445-1453. DOI: 10.1093/eurheartj/ehv090
9. Pelliccia A, Kinoshita N, Pisicchio C, et al. Long-term clinical consequences of intense, uninterrupted endurance training in Olympic athletes. J Am Coll Cardiol. 2010. 55(15),16191625. DOI: 10.1016/j.jacc.2009.10.068
10. Pelliccia A, Sharma S, Gati S, et al. 2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease. Eur Heart J. 2021. 42(1), 17-96. DOI: 10.1093/eurheartj/ehaa605
11. Charfeddine S, Mallek S, Triki F, et al. Echocardiographic analysis of the left ventricular function in young athletes: a focus on speckle tracking imaging. Pan Afr Med J. 2016. 25,171. DOI: 10.11604/pamj.2016.25.171.10032
12. Khan AA, Safi L, Wood M. Cardiac Imaging In Athletes. Methodist Debakey Cardiovasc J. 2016. 12(2), 86-92. DOI: 10.14797/mdcj-12-2-86
13. Fagard R. Athlete's heart. Heart. 2003. 89(12), 1455-1461. DOI: 10.1136/heart.89.12.1455
14. Elliott PM, Anastasakis A, Borger MA, et al. 2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy: the Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC). Eur Heart J. 2014. 35(39), 2733-2779. DOI: 10.1093/eurheartj/ehu284
15. Malhotra A, Sharma S. Hypertrophic cardiomyopathy in athletes. Eur Cardiol Rev. 2017. 12(2), 80. DOI: 10.15420/ecr.2017:16:1
16. Prior D, La Gerche A. Exercise and arrhythmogenic right ventricular cardiomyopathy. Heart Lung Circ. 2020. 29(4), 547-555. DOI: 10.1016/j.hlc.2019.12.007
17. Corrado D, Zorzi A, Cerrone M, et al. Proposed diagnostic criteria for arrhythmogenic cardiomyopathy: European Task Force consensus report. Int J Cardiol. 2024. 395, 131447. DOI: 10.1016/j.ijcard.2023.131447
18. Molossi S, Mery CM. Controversies Surrounding Coronary Arteries Anomalies in Young Athletes. American College of Cardiology. 2015.
19. Rajpal S, Tong MS, Borchers J, et al. Cardiovascular magnetic resonance findings in competitive athletes recovering from COVID-19 infection. JAMA Cardiol. 2021. 6(1),116-118. DOI: 10.1001/jamacardio.2020.4916
20. Clark DE, Parikh A, Dendy JM, et al. COVID-19 myocardial pathology evaluation in athletes with cardiac magnetic resonance (COMPETE CMR). Circulation. 2021.143(6), 609-612. DOI: 10.1161/CIRCULATIONAHA.120.052573
21. Merghani A, Maestrini V, Rosmini S, et al. Prevalence of subclinical coronary artery disease in masters endurance athletes with a low atherosclerotic risk profile. Circulation. 2017. 136, 126-137. DOI: 10.1161/CIRCULATIONAHA.116.026964
22. Chhabra L, Goyal A, Benham MD. Wolff-Parkinson-White Syndrome. StatPearls. 2023.
23. Charron P, Villard E, Sébillon P, et al. Danon disease as a cause of hypertrophic cardiomyopathy in women. Am J Cardiol. 2004. 93(8), 1022-1026. DOI: 10.1016/j.amjcard.2004.01.021
24. Han J, Lalario A, Merro E, et al. Sudden Cardiac Death in Athletes: Facts and Fallacies. J Cardiovasc Dev Dis. 2023. 10(2). DOI: 10.3390/jcdd10020085
25. Sharma S, Drezner JA, Baggish A, et al. International recommendations for electrocardiographic interpretation in athletes. J Am Coll Cardiol. 2017. 69(8), 1057-1075. DOI: 10.1016/j.jacc.2017.01.015
26. Asif IM, Drezner JA. Sudden cardiac death and preparticipation screening: the debate continues. Curr Sports Med Rep. 2012. 11(2), 62-68. DOI: 10.1249/JSR.0b013e318251c9f2.
27. Dores H, Dinis P, Viegas JM, et al. Preparticipation Cardiovascular Screening of Athletes: Current Controversies and Challenges for the Future. Diagnostics. 2024. 14(21). DOI: 10.3390/diagnostics14212440
28. Friedrich MG, Sechtem U, Schulz-Menger J, et al. Cardiovascular magnetic resonance in myocarditis: A JACC White Paper. J Am Coll Cardiol. 2009. 53(17), 1475-1487. DOI: 10.1016/j.jacc.2009.02.007
29. Priori SG, Blomström-Lundqvist C, Mazzanti A, et al. 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J. 2015. 36(41), 2793-2867. DOI: 10.1093/eurheartj/ehv316
30. Rigelsky C, Zahka KG. Genetic evaluation of athletes with cardiovascular disease: Incorporating a genetic counselor on your team. American College of Cardiology. 2017.
31. Kim JH, Baggish AL, Levine BD, et al. Clinical considerations for competitive sports participation for athletes with cardiovascular abnormalities: a scientific statement from the American Heart Association and American College of Cardiology. J Am Coll Cardiol. 2025. 85(10), 1059-1108. DOI: 10.1016/j.jacc.2024.12.017
32. Drezner JA, Rao AL, Heistand J, et al. Effectiveness of emergency response planning for sudden cardiac arrest in United States high schools with automated external defibrillators. Circulation. 2009. 120(6), 518-525. DOI: 10.1161/CIRCULATIONAHA.109.855890
33. Astley C, Petek BJ, DeLong RN, et al. Sudden Cardiac Arrest Among Young Competitive Athletes Before and During the COVID-19 Pandemic. JAMA Netw Open. 2025. 8(2),e2461327. DOI: 10.1001/jamanetworkopen.2024.61327
34. Hannun AY, Rajpurkar P, Haghpanahi M, et al. Cardiologist-level arrhythmia detection and classification in ambulatory electrocardiograms using a deep neural network. Nat Med. 2019. 25(1), 65-69. DOI: 10.1038/s41591-018-0268-3
35. Seshadri DR, Bittel B, Browsky D, et al. Accuracy of Apple Watch for detection of atrial fibrillation. Circulation. 2020. 141(8), 702-703. DOI: 10.1161/CIRCULATIONAHA.119.044126
36. Task Force Members, Monserrat L, Elliott PM, et al. Non-invasive prediction of sudden arrhythmic death in hypertrophic cardiomyopathy: the HCM Risk-SCD model. Eur Heart J. 2018. 39(22), 2058-2064. DOI: 10.1093/eurheartj/ehy102.