Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington.
Department of Family Medicine, Sports Medicine Section and UW Medicine Center for Sports Cardiology, University of Washington, Seattle, Washington.
Sports Health. 2021 Nov-Dec;13(6):622-629. doi: 10.1177/19417381211004877. Epub 2021 Mar 18.
Limited data are available to guide cardiovascular screening in adult or masters athletes (≥35 years old). This review provides recommendations and the rationale for the cardiovascular risk assessment of older athletes.
Review of available clinical guidelines, original investigations, and additional searches across PubMed for articles relevant to cardiovascular screening, risk assessment, and prevention in adult athletes (1990-2020).
Clinical review.
Level 3.
Atherosclerotic coronary artery disease (CAD) is the leading cause of exercise-induced acute coronary syndromes, myocardial infarction, and sudden cardiac death in older athletes. Approximately 50% of adult patients who experience acute coronary syndromes and sudden cardiac arrest do not have prodromal symptoms of myocardial ischemia. The risk of atherosclerotic cardiovascular disease (ASCVD) can be estimated by using existing risk calculators. ASCVD 10-year risk is stratified into 3 categories: low-risk (≤10%), intermediate-risk (between 10% and 20%), and high-risk (≥20%). Coronary artery calcium (CAC) scoring with noncontrast computed tomography provides a noninvasive measure of subclinical CAD. Evidence supports a significant association between elevated CAC and the risk of future cardiovascular events, independent of traditional risk factors or symptoms. Statin therapy is recommended for primary prevention if 10-year ASCVD risk is ≥10% (intermediate- or high-risk patients) or if the Agatston score is >100 or >75th percentile for age and sex. Routine stress testing in asymptomatic, low-risk patients is not recommended.
We propose a comprehensive risk assessment for older athletes that combines conventional and novel risk factors for ASCVD, a 12-lead resting electrocardiogram, and a CAC score. Available risk calculators provide a 10-year estimate of ASCVD risk allowing for risk stratification and targeted management strategies. CAC scoring can refine risk estimates to improve the selection of patients for initiation or avoidance of pharmacological therapy.
成人或大师级运动员（≥35 岁）的心血管筛查数据有限。本综述为年龄较大的运动员的心血管风险评估提供了建议和依据。
对可获得的临床指南、原始研究以及 PubMed 中与成人运动员心血管筛查、风险评估和预防相关的文章进行了综合检索。
临床综述。
3 级。
动脉粥样硬化性冠状动脉疾病（CAD）是导致老年运动员运动性急性冠状动脉综合征、心肌梗死和心源性猝死的主要原因。约 50%经历急性冠状动脉综合征和心源性猝死的成年患者没有心肌缺血的前驱症状。现有的风险计算器可用于估计动脉粥样硬化性心血管疾病（ASCVD）的风险。ASCVD 10 年风险分为 3 个类别：低危（≤10%）、中危（10%-20%）和高危（≥20%）。非增强计算机断层扫描（CT）冠状动脉钙评分提供了亚临床 CAD 的非侵入性测量方法。证据表明，在传统危险因素或症状之外，CAC 升高与未来心血管事件的风险之间存在显著相关性。如果 10 年 ASCVD 风险≥10%（中危或高危患者）或 Agatston 评分>100 或>年龄和性别 75 百分位，则推荐他汀类药物进行一级预防。不建议对无症状、低危患者进行常规应激试验。
我们提出了一种针对老年运动员的综合风险评估方法，该方法结合了 ASCVD 的传统和新型危险因素、常规 12 导联静息心电图和 CAC 评分。现有的风险计算器可提供 ASCVD 风险的 10 年估计值，从而进行风险分层和有针对性的管理策略。CAC 评分可以细化风险估计值，以提高选择开始或避免药物治疗的患者的准确性。
