Coronary Artery Disease in Masters Athletes: A Systematic Review

Background Despite undertaking large volumes of structured exercise training, evidence suggests that masters athletes (MAs) remain susceptible to coronary artery disease (CAD). This review evaluated the prevalence and nature of CAD in MAs. Methods PubMed, Medline, EMBASE, Web of Science and Cochrane Library were searched on 23 November 2024, from 1 January 2000. MAs were defined as apparently healthy individuals aged ≥ 35 years with an exercise training history indicative of regular engagement in sporting activity. The Appraisal tool for Cross-Sectional Studies (AXIS) was used to assess study quality. Results A total of 17 studies reporting various measures of CAD in 2749 MAs (2127 male, 622 female) were included. Coronary artery calcium (CAC) was present in a significant proportion, with 565 MAs scoring > 0, and 179 and 43 MAs exceeding thresholds of > 100 and > 400, respectively. Evidence of plaque was detected in at least 458 MAs. This was predominantly calcified in the majority of cases. Obstructive disease (> 50% stenosis) was also identified in at least 51 MAs. Conventional cardiovascular (CV) risk factors such as smoking, dyslipidaemia, hypertension and diabetes were prevalent in this population. Discussion Clinical and methodological heterogeneity made it challenging to perform accurate quantitative analyses. However, our data reiterate that MAs are not invulnerable to CAD. Long-term and high-intensity endurance training may be associated with changes that predispose to atherosclerotic disease. Female MAs, and those from low- and middle-income countries, are markedly underrepresented in literature. Conclusion A more individualised approach to CV risk assessment may be warranted in the future to guide early CAD detection and subsequent management. Registration PROSPERO 2024 CRD42024607539.