UBC Theses and Dissertations
Evaluation of pre-participation screening and cardiovascular risk assessment in Masters athletes in British Columbia Morrison, Barbara Nicole
Background: Middle-aged individuals (≥ 35 years) are exercising more and living longer. Vigorous exercise can transiently increase the risk of sudden cardiac death (SCD) in those with underlying cardiovascular disease (CVD). Pre-participation screening (PPS) can detect CVD. The optimal screening method in Masters athletes is unclear. Suggested methods include cardiovascular history questionnaire, physical examination, cardiovascular risk scores, resting electrocardiogram (ECG), exercise treadmill test (ETT), and imaging techniques. Purpose: To evaluate the prevalence of CVD and risk factors and the effectiveness of different screening methods for detecting cardiovascular risk in Masters athletes to prevent SCD in sport. To determine the prevalence of atrial fibrillation (AF) in Masters athletes, and its association with volume of activity. Methods: This is a prospective observational study that evaluated Masters athletes from a variety of sports. The initial screen consisted of a physical examination, a resting ECG, Framingham Risk Score (FRS), an American Heart Association (AHA) questionnaire, and a physical activity and lifestyle questionnaire. If the initial screen was abnormal, the participant went on for further evaluations according to criteria defined a priori. CVD was confirmed by follow-up examinations and a positive predictive value (PPV) determined the effectiveness of the screening tools. Results: A total of 297 athletes (67% male, mean age 54 ± 8.8, range 35-81 years) were included. The prevalence of CVD was 12% and 9% had a high FRS. CAD was the most frequent diagnosis (9%). Three (1%) athletes were diagnosed with AF. A high cardiovascular risk score was the most effective tool in detecting CAD (56% PPV), and the AHA questionnaire produced the greatest number of false-positives (82%). There was a greater prevalence of AF and valvular heart disease in those with greater volumes of physical activity. Conclusion: Physically fit, asymptomatic Masters athletes are not immune to cardiovascular risk factors and have significant CVD. Systematic screening amongst Masters athletes may be reasonable; however, more research is needed to refine the current PPS methods to better suit the Masters athlete population.
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