Caring for the Masters Athlete: Why Heart Health Matters After 35
Staying active is one of the best things you can do for your heart. Many adults continue running, cycling, swimming, or competing in sports well into their 40s, 50s, and beyond. These athletes are known as Masters athletes.
But as athletes age, their heart risks change. In younger athletes, sudden cardiac death is usually caused by rare heart muscle diseases or electrical problems. After age 35, the most common cause shifts to coronary artery disease (blockages in the heart arteries) [1].
That’s why Masters athletes need a tailored approach to cardiovascular care — one that balances safety, performance, and longevity.
Why Masters Athletes Need Special Heart Care
Even if you feel fit, traditional risk factors still matter:
High cholesterol
High blood pressure
Diabetes
Smoking history
Family history of early heart disease
A large study of long-distance runners found that cardiac arrest during races is rare, but when it does occur in Masters athletes, coronary artery disease is the leading cause [2].
The Role of Coronary Calcium Scoring
A coronary artery calcium (CAC) score is a CT scan that measures plaque buildup in the arteries.
A CAC score over 300 is associated with higher risk, similar to people who already have heart disease [3].
Masters athletes sometimes show higher CAC, but often with more calcified (stable) plaque rather than unstable types [4,5].
Fitness level matters: in the Cooper Center study, men with high CAC who were very fit still had much lower risk of heart events [6].
The key message: calcium scores must be interpreted in the context of your athletic lifestyle.
Cholesterol and Statins
Many athletes worry that cholesterol medications (statins) will hurt performance.
The good news: research shows statins do not reduce VO₂ max (a key fitness measure), though some people experience muscle aches [7].
If statins aren’t tolerated, there are other safe and effective options, such as ezetimibe, bempedoic acid, and PCSK9 inhibitors.
Blood Pressure in Athletes
High blood pressure should be treated, but the approach may differ in athletes:
Caffeine, energy drinks, and anabolic steroids can raise blood pressure.
ACE inhibitors, ARBs, or calcium channel blockers are usually best tolerated.
Diuretics and beta-blockers can affect performance and may be restricted in some sports.
Nutrition and Supplements
A healthy diet is crucial for long-term performance and cardiovascular safety:
Prioritize plant-based proteins and fish over red meat.
Limit saturated fats.
Ensure enough protein to maintain muscle mass with aging.
Testosterone and supplements: Testosterone use is common among Masters athletes. A recent study showed it was safe in men with low testosterone [8], but its safety for athletes without a medical need is unproven. Always review supplements with your doctor.
Is Exercise Still Safe?
Some studies show lifelong endurance athletes may develop more coronary plaque [4,5]. But here’s the important part:
Highly active athletes with higher CAC do not have higher mortality.
In fact, exercise still protects against heart attacks and death [9].
The bottom line: don’t stop exercising — but do make sure your heart is monitored appropriately.
Key Takeaways for Masters Athletes
After age 35, coronary artery disease is the biggest heart risk.
Screening and prevention matter, even for athletes who feel fit.
Calcium scores and cholesterol levels should be interpreted carefully in the context of athletic training.
Exercise remains protective — staying active reduces long-term risk.
Partner with a sports cardiologist to balance performance goals with heart health.
Ready to Protect Your Heart?
At Max Heart Health, we specialize in caring for athletes of all ages — from competitive runners to lifelong fitness enthusiasts. If you’re a Masters athlete and want to ensure your heart is as strong as your performance, schedule a consultation today.
References
Corrado D, et al. JACC Cardiovasc Imaging. 2013;6:993–1007.
Kim JH, et al. N Engl J Med. 2012;366:130–140.
Budoff MJ, et al. JACC Cardiovasc Imaging. 2023;16.
Aengevaeren VL, et al. Circulation. 2017;136:138–148.
De Bosscher R, et al. Eur Heart J. 2023;44:2388–2399.
Radford NB, et al. Circulation. 2018;137:1888–1898.
Parker BA, et al. Circulation. 2013;127:96–103.
Lincoff AM, et al. N Engl J Med. 2023;389:203–214.
DeFina LF, et al. JAMA Cardiol. 2019;4:174–181.
