Learn about the causes, risk factors, and screening of sudden cardiac death in young athletes. Discover how rapid AED use and emergency plans save lives.
Imagine you are running on your favorite trail. You are breathing hard, and your legs feel heavy. Suddenly, a runner with gray hair and a steady stride zips right past you. They look like they could keep that pace all day. It is a common sight today - "master athletes" in their 60s and 70s who are faster and fitter than people half their age.
Imagine a high-end sports car. It is sleek, shiny, and built to handle the toughest races. On the outside, it looks absolutely perfect. But deep inside the engine, there is a tiny fuel line that has started to rust. Normally, a "check engine" light would flash on the dashboard to warn the driver that something is wrong. However, in this car, someone has placed a thick piece of black tape over the light. The driver keeps pushing the car to its limits, feeling invincible, totally unaware that the engine is struggling. Suddenly - at 100 miles per hour - the engine stalls.
Many people feel a deep fear when they hear the words "clogged arteries." We often think of our heart like the plumbing in an old house. We imagine that over time, the pipes get filled with thick gunk. In this simple view, if the pipes are clear, you are healthy. If the pipes are full of gunk, you are in big trouble. We assume that people who exercise a lot will have the cleanest pipes of all.
Imagine your body is a giant, bustling city. For the city to work, it needs one massive main water pipe to carry energy and supplies to every single house. In your body, that "water main" is a giant tube called the aorta. Doctors call it the "Great Vessel" because it is the biggest and most important power line in your system.
For decades, doctors and runners shared a comfortable belief: if you ran marathons, your heart was bulletproof. This was known as the "Bassler hypothesis," the idea that finishing a 26-mile race gave you a "get out of jail free" card against heart disease. However, as modern heart scans improved, doctors were met with a shock. The very people who were the fittest on the planet—lifelong marathoners and cyclists—often showed more "rust" or buildup in their heart pipes (arteries) than people who sat on the couch.
The landscape of preventive cardiology has undergone a profound transformation with the emergence of subclinical imaging, specifically the quantification of coronary artery calcium (CAC). For decades, cardiovascular risk assessment relied almost exclusively on probabilistic models derived from population-wide observational data.
Can an elite athlete have heart disease? Short answer: yes. I’m a lifelong endurance cyclist—now 65 years old - with three national records and two world records. I once believed fitness was protection.
Short answer: yes. I’m a lifelong endurance cyclist—now 65 years old—with three national records and two world records. I once believed fitness was protection. But heart disease doesn’t care how fit you are. This is how I went from five blocked arteries to another world record—and what athletes can do to protect their hearts.
Q: Are endurance athletes really at higher risk for atrial fibrillation?
A: Yes. Atrial fibrillation (AF) is common in the general population, with a lifetime risk of roughly 1 in 4 adults.¹ While moderate exercise protects cardiovascular health, long-term, high-volume endurance training is associated with significantly higher AF rates. Meta-analyses show endurance athletes have about 2.5–3.6× higher odds of AF than non-athletes.
Meet the "Masters Athlete." This is a person over age 50 who feels like they are in the prime of their life. They run long races, bike for hundreds of miles, and spend hours in the pool. To the outside world, they look like the picture of health. They have a slow, steady resting pulse and plenty of energy.
