Cardiovascular Risk Profile in Master Paralympic Athletes, a High-Risk Undertreated Population: A Cross-Sectional Longitudinal Study

IntroductionRecently, European Society of Cardiology (ESC) validated a prediction model to estimate 10-year fatal and non-fatal cardiovascular disease risk (CVDR) in individuals (aged 40-60 years) without previous cardiovascular disease or diabetes (ESC-SCORE2) and to provide indications for treatment. At present, data describing the CVDR in Paralympic athletes (PAs) are scarce and inconsistent. Therefore, we sought to assess the prevalence of risk factors in PAs to estimate their CVDR through SCORE2.MethodsWe enrolled 99 PAs aged >= 40 y.o., who participated at 2012-2022 Paralympic Games, competing in 22 different sport disciplines classified according to sport type (power, skills, endurance and mixed) and disabilities: spinal cord injuries (SCI) and non-SCI. CVDR factors, anthropometric measurements and blood samples were collected.ResultsAmong the 99 PAs (78% males, mean age 45.7 +/- 4.7 y.o.), 52.5% had SCI; 54% were dyslipidemic and 23% were smokers. According to ESC-SCORE2, 29% had high and 1% very-high CVDR. Women (compared to men) and endurance (compared to other sport) exhibited better CV profile. SCI showed no differences when compared with non-SCI for CVDR, excepted for a lower HDL and lower exercise performance. None of the dyslipidemic athlete was on pharmacologically treatment, despite the altered lipid profile had already been detected at younger age.ConclusionPAs are a selected population, presenting a high CV risk profile, with 30% showing either high or very-high CVDR according to ESC-SCORE2. Dyslipidemia was the most common risk factor, underestimated and undertreated, emphasizing the need for specific preventive strategies in this special setting of athletes.Graphical AbstractSummary of main findings of our study: 30% of PAs presented an high to very-high SCORE2. PAs practicing endurance disciplines and female athletes presented a better CV risk profile and a lower SCORE2, while no differences where highlighted between SCI and NSCI athletes. A high prevalence of CV risk factors was found, mostly uncorrected over time and untreated.