Study Assesses the Prevalence of Clinically Relevant Aortic Dilatation in Aging Masters-Level Athletes

A new study highlighted the relationship between ascending aortic dilatation and long-term endurance exercise in aging masters-level athletes.

“Aortic dilatation is frequently encountered in clinical practice among aging endurance athletes, but the distribution of aortic sizes in this population is unknown,” the authors wrote. “It is additionally uncertain whether this may represent aortic adaptation to long-term exercise, similar to the well-established process of ventricular remodeling.”

They conducted a cross-sectional study of veteran endurance athletes aged between 50 and 75 years. Recruitment of masters-level rowers and runners from nationwide competitive athletic events took place between February 2018 and October 2018; data analysis started in January 2019. The main outcome was aortic size at the sinuses of Valsalva and the ascending aorta as determined using transthoracic echocardiography. Published nomograms were referenced to predict aortic dimensions based on age, sex, and body size. When relevant, z scores were calculated. Clinically relevant aortic dilatation was defined as a diameter at sinuses of Valsalva or ascending aorta ≥40 mm.

Older Athletes Commonly Present Clinically Relevant Aortic Dilatation

Final analysis included 442 athletes, with a mean (SD) age of 61 (6) years, of whom 267 (60%) were male. A similar proportion of rowers (n=228; 52%) and runners (n=214; 48%) was included for analysis. Among the total cohort, clinically relevant aortic dilatation was observed in about one-fifth (n=94, 21%) of participants: 83 (31%) men and 11 (6%) women. In published nomograms comparisons, a rightward shift with a rightward tail was observed in the distribution of measured aortic size (P<0.001 for all). Just under a quarter of participants (n=105; 24%) had at 1 z score ≥2, which is associated with an aortic measurement >2 SDs higher than the mean of the population. When adjusting for age, sex, body size, hypertension, and statin use, independent associations were observed between both elite competitor status (rowing participation in world championships or Olympics or marathon time under 2 hours and 45 minutes) and sport type (rowing) and aortic size.

The study was published in JAMA Cardiology.

“Clinically relevant aortic dilatation is common among aging endurance athletes, raising the possibility of vascular remodeling in response to long-term exercise,” wrote the researchers. “Longitudinal follow-up is warranted to establish corollary clinical outcomes in this population.”