What Is the Main Idea?

Sudden death among competitive athletes is most often connected to undiscovered problems with the heart, which are harder to detect in athletes older than 40 years. Most sport-related sudden deaths now occur in this age group.

The authors of the open-access editorial comment “The Challenges of Screening Master Athletes”, published in the journal Cardiology, reported on a study comparing different heart health screening methods for marathon runners (published in the same journal issue). The editorial authors highlighted the difficulties of screening but also described possible ways to reduce the risk of sudden death during exercise.

What Else Can You Learn?

You can learn about heart conditions and tests to discover them.

Take-Home Message

For endurance sports athletes aged over 40 years, careful and detailed medical examination can reveal unknown heart conditions, leading to treatment or emergency action plans that can ultimately help prevent sudden death during exercise.

What Is Sudden Death?

In the context of this article, sudden death refers to when an athlete unexpectedly collapses and dies as a result of an unknown heart problem. Usually this happens during intense exercise, when the heart is most stressed.

What Is Screening?

Screening is medical testing to discover any problems with the body or mind. The benefits of screening are that conditions can be discovered and treated early, or a person can know as much as possible before making a health decision. Many of us may attend regular screening appointments, to test for cancer or other conditions. Screening can also be carried out as a one-off preparation before or after an event such as surgery or childbirth. Testing can be in the form of blood and urine tests, questionnaires, x-ray or other imaging, or other specialist tests. In the case of this article, screening refers to tests carried out before the athletes start a training program, or when they reach a specific age.

What Are Master Athletes?

Master athletes are people over the age of 40 who participate in high-intensity endurance sports, such as running and cycling.

Why Must Master Athletes Be Considered Differently to “Young” Athletes?

The causes of cardiac arrest and sudden death in master athletes are different from that of younger athletes. In master athletes, these causes are most often connected to coronary artery diseases.

Also, the number of people aged over 40 competing in high-intensity endurance sports is increasing. For example, studies have shown that almost half of marathon runners are now over 40 years old. Therefore, heart associations are recognizing this increased need for attention.

What Are Coronary Artery Diseases?

Known in short as CAD, these are diseases that affect the main blood vessels leading to the heart, called coronary arteries (coronary is a term that refers to the heart). The vessels can become narrowed, inflamed, or blocked, causing life-threatening problems if blood cannot get through to the heart. This problem is particularly dangerous during intense exercise, when the heart must work harder and blockages can suddenly occur.

What Type of Screening Do the Authors Recommend for Master Athletes?

  • History and physical examination (e.g., family risk, blood pressure).
  • Blood tests (in particular glucose and lipid (fats) information).
  • Resting electrocardiogram (ECG) – this tests the heart’s electrical function.
  • Exercise testing – this tests the heart’s function during exercise, to see if it changes or if it can “cope”.

What Preventative Measures Are Available?

If a heart problem is identified, the athlete can start treatment, or make a decision about their sport activity and risk of heart problems using the new information. The athlete can also ensure that they have medical care and a plan, should they have an emergency whilst competing.

The authors presented the concept of the Swiss Cheese metaphor, to describe the best preventative approach.

What Is the Swiss Cheese Metaphor?

A slice of Swiss cheese has many holes. When it comes to thinking about preventing a master athlete suddenly dying from a heart problem, these holes represent all the problems that could be screened. Each slice can represent a screening method. If there is only one slice (1 screening method), then there will be a hole, resulting in a medical problem. However, if we line up several slices of cheese (use many screening methods), the holes do not form one “tunnel” but are blocked by other slices of cheese. Joining the slices together is like using many different types of screening to reduce the risk of sudden death. The authors refer to this as “multiple layers of defense”.

What Did This Study Show?

Screening cannot identify every unknown heart disease, or fully predict a heart emergency. This is especially true for master athletes who are more at risk of CAD. However, screening is important because it can discover unknown problems, even in an apparently healthy and fit master athlete. Thus, screening can help to save lives.


Share your opinion with us and leave a comment below!

Alessandro Zorzi 16.04.2024 at 14:39

Thank you very much for this fantastic summary of our editorial. I hope it will make amateur athletes +40 years old think about the importance of regular medical examinations. Kind regards. Alessandro Zorzi, MD, PhD (Padua, Italy)

Alexander Eitner (Editorial Office) 16.04.2024 at 15:13

Dear Dr Zorzi, many thanks for your kind words. With kind regards, Editorial Office