Cardiovascular screening of master athletes. Insights from the Master Athletes Screening Study

The master athlete (MA) is generally an individual ≥35 years old who trains and participates in specifically designed competitions. Master athletes are former professional athletes who wish to continue competition, usually in a different sport, or individuals who return to competitive sports after a period of inactivity or who decide to start training systematically in adult life to improve their fitness. While the systematic practice of physical activity matches with the holistic concept of active ageing, the ever-increased participation of MAs in competitions requires tailoring an appropriate pre-participation screening (PPS) that addresses the increased cardiovascular (CV) risk of this population.1 Cardiovascular prevention is a lifelong process from the cradle to the grave and beyond,2 but if paediatric athletes are predominantly affected by congenital and genetic diseases,3 MAs are mainly affected by coronary artery disease (CAD); ischaemic and non-ischaemic myocardial fibrosis; supraventricular tachyarrhythmias, in particular atrial fibrillation; and aortic dilatation.1 In this issue, Morrison et al.4 present the results of the Master Athletes Screening Study (MASS), a 5-year prospective study, which represents an important step forward in the definition of an appropriate PPS protocol in MAs, a growing athletic population. The inclusion criteria were not very strict, as eligible participants had to engage in moderate to vigorous intensity physical activity at least 3 days per week during the preceding 3 months.4 The authors included 798 MAs who underwent CV screening on a yearly basis including personal and family history, sport practice and the use of drugs,5 12-lead electrocardiogram (ECG), resting blood pressure, anthropometrics, and Framingham Risk Score (FRS). Those presenting abnormal findings underwent stress ECG (Stage 2) and/or a consultation with a sports cardiologist or other evaluations (Stage 3). The participants were then followed up for 4 years to record major adverse cardiac events (MACE) (sudden cardiac arrest/death, myocardial infarction, stroke), and additional CV diagnoses, as arrhythmias (37%), which were the most common finding during follow-up. Major adverse cardiac events occurred despite yearly screening in 10 male MAs (2.8/1000 athlete-years) who had an abnormal cardiac screening, but cardiac functional tests (i.e. echocardiogram, electrocardiogram, nuclear) failed to detect the underlying CAD in most cases. It