Vademecum for the Physician Evaluating a Master Athlete

The number of master athletes (MAs) is steadily increasing, reflecting broader societal trends in healthy aging and competitive sports participation beyond the age of 35. This work presents an up-to-date, evidence-based framework for evaluating the cardiovascular and general health of master athletes, integrating current guidelines with sport-specific considerations, and focusing primarily on cardiovascular prevention and risk management. It also acknowledges conditions that are more prevalent in this population-accelerated coronary calcification/coronary artery disease, endurance-related atrial fibrillation, and mild aortic enlargement-within the preventive assessment framework.

While regular exercise confers significant cardiovascular and metabolic benefits, aging athletes present unique clinical challenges requiring tailored assessment and management strategies. Current evidence highlights the importance of recognizing both traditional and sport-specific risk factors, employing appropriate diagnostic modalities (including advanced imaging when indicated), and implementing an integrated approach combining lifestyle, pharmacological, and procedural interventions. MAs require individualized, multidisciplinary care to ensure safe and sustained participation in sports. Early detection and targeted management of cardiovascular and metabolic risk factors, along with ongoing surveillance, are essential for preserving health, performance, and quality of life in this growing population.