Article Text

Download PDFPDF

Assessment of cardiovascular risk and preparticipation screening protocols in masters athletes: the Masters Athlete Screening Study (MASS): a cross-sectional study
  1. Barbara N Morrison1,2,
  2. James McKinney2,3,
  3. Saul Isserow2,3,
  4. Daniel Lithwick4,
  5. Jack Taunton5,
  6. Hamed Nazzari2,3,
  7. Astrid M De Souza6,
  8. Brett Heilbron2,3,
  9. Carlee Cater2,
  10. Mackenzie MacDonald2,
  11. Benjamin A Hives7,
  12. Darren E R Warburton1,7
  1. 1 Experimental Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
  2. 2 SportsCardiologyBC, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
  3. 3 Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
  4. 4 Healthcare Policy and Research, Weill Cornell Medical College, New York City, New York, USA
  5. 5 Division of Sports Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
  6. 6 Children’s Heart Centre, BC Children's Hospital, Vancouver, British Columbia, Canada
  7. 7 School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
  1. Correspondence to Barbara N Morrison; bmorrison{at}


Background Underlying coronary artery disease (CAD) is the primary cause of sudden cardiac death in masters athletes (>35 years). Preparticipation screening may detect cardiovascular disease; however, the optimal screening method is undefined in this population. The Physical Activity Readiness Questionnaire for Everyone (PAR-Q+) and the American Heart Association (AHA) Preparticipation Screening Questionnaire are often currently used; however, a more comprehensive risk assessment may be required. We sought to ascertain the cardiovascular risk and to assess the effectiveness of screening tools in masters athletes.

Methods This cross-sectional study performed preparticipation screening on masters athletes, which included an ECG, the AHA 14-element recommendations and Framingham Risk Score (FRS). If the preparticipation screening was abnormal, further evaluations were performed. The effectiveness of the screening tools was determined by their positive predictive value (PPV).

Results 798 athletes were included in the preparticipation screening analysis (62.7% male, 54.6±9.5 years, range 35–81). The metabolic equivalent task hours per week was 80.8±44.0, and the average physical activity experience was 35.1±14.8 years. Sixty-four per cent underwent additional evaluations. Cardiovascular disease was detected in 11.4%, with CAD (7.9%) being the most common diagnosis. High FRS (>20%) was seen in 8.5% of the study population. Ten athletes were diagnosed with significant CAD; 90% were asymptomatic. A high FRS was most indicative of underlying CAD (PPV 38.2%).

Conclusion Masters athletes are not immune to elevated cardiovascular risk and cardiovascular disease. Comprehensive preparticipation screening including an ECG and FRS can detect cardiovascular disease. An exercise stress test should be considered in those with risk factors, regardless of fitness level.

  • cardiology prevention
  • cardiovascular
  • aging
  • athlete
  • sports

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

View Full Text

Statistics from


  • Contributors BNM, JM, SI and DERW were responsible for the conception and design of the study. BNM and BAH conducted the analyses, which were checked by all coauthors. All authors contributed to the interpretation of the findings. BNM, JM, SI, DL, HN, CC, MM, BH and BAH all assisted with data collection over the study period. BNM wrote the first draft of the paper, which was critically revised by JM, AMDS and DERW. The final manuscript was approved by all authors. BNM is the study guarantor.

  • Funding This study was supported by a grant from MITACs and CIHR (FRN 157930). VGH and UBC Hospital Foundation provided financial and material support.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval The University of British Columbia Clinical Research Ethics Board approved this study (H15-00009).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement This is a 5-year study, so data collection is ongoing. The data come from the SportsCardiologyBC clinic, which will not be made available to other researchers.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.