Question 1

What is the main cardiovascular risk in the older athlete?

Accepted Answer

In masters athletes, conventionally those aged 35 and over, the leading cause of exercise-related sudden cardiac death is atherosclerotic coronary artery disease, rather than the inherited conditions that dominate in the young. Warning symptoms are often absent, so assessment also considers risk factors and selective testing.

Question 2

How is cardiovascular risk assessed in the older athlete?

Accepted Answer

With the history and examination, a review of risk factors and, in the UK, QRISK3 for primary prevention in adults aged 25 to 84. Atorvastatin 20 mg is offered after discussion at a 10-year risk of 10% or more. A resting ECG is used selectively, and CT coronary angiography is first-line for suspected stable angina.

Question 3

Should an older athlete with coronary calcium stop exercising?

Accepted Answer

Not on the basis of the calcium score alone. Calcification is evidence of coronary atherosclerosis with prognostic importance, so a raised score is not treated as benign. Once symptoms and inducible ischaemia have been excluded, continued exercise is generally encouraged, with the prescription tailored to the findings.

Question 4

Why do endurance athletes get atrial fibrillation?

Accepted Answer

The risk is increased, most evidently in men with long-term, high-volume endurance exposure. Proposed mechanisms, including raised vagal tone, atrial stretch and fibrosis, remain hypotheses. New palpitations or an unexplained drop in performance in a masters athlete are investigated rather than assumed to be benign.

Cardiovascular Assessment in the Older Athlete

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