Are Athletes At Risk Of Aortic Disease

Competitive athletes are typically the fittest among us. So it's easy to assume they're also the healthiest. And since exercise is so important to heart health, it stands to reason that all high-level athletes would have strong, healthy hearts.

But the occasional (and utterly terrifying) story of a player collapsing on the field from an undiagnosed heart condition may give some athletes pause. While it's true that having a preexisting aneurysm or other type of aortic disease can require more monitoring, these conditions are very rare. It's also important to note that most cases of sudden cardiac death in athletes doesn't result from aortic disease but from an inherited heart anomaly.

And for most active people, there's no need to slow down. "Exercise is one of the best things you can do for your heart," says Kyle Miletic, M.D., a cardiac surgeon at Henry Ford Health. "Even in athletes who are at risk for aortic disease, continuing to exercise is important for keeping blood pressure in check."

What Is Aortic Disease?

Aortic disease is an overall term used to describe a variety of conditions that affect the aorta-the main artery that carries blood from the heart to the rest of the body. The aorta runs from the heart through the chest and into the abdomen.

The two most common types of aortic disease are:

• Aortic aneurysm, a bulge or enlargement of the aorta. The aneurysm can develop anywhere along the aorta. Aneurysms can rupture (burst) and cause internal bleeding.
• Aortic dissection, when the force of blood pumping through the aorta causes the inner lining to tear away from the outer layers.

Both an aneurysm rupture and a dissection are emergency situations. They require immediate surgical treatment and, in some cases, can be fatal.

Some Athletes Do Have Enlarged Aortas

Research has established that long-term, high-intensity exercise can make the heart larger. Endurance athletes tend to have larger hearts than people who are more sedentary. But this seems to be a healthy adaptation in response to exercise-not a risk factor for aortic disease.

"There still are no great studies that definitively link high-level exercise to aortic aneurysms or dissections," says Dr. Miletic. "But some have found a slightly higher incidence of aortic enlargement in athletes over the general public." One study found that about 30% of former NFL players did have significantly larger aortas than a control group of non-athletes.

But there's still no strong evidence connecting larger aortas in athletes with increased risk of aortic disease. Some experts theorize that, like a larger heart, a larger aorta may be a healthy change brought about by intense exercise.

Who Should Be Screened For Aortic Aneurysm Or Dissection?

"There isn't strong enough data to suggest that every athlete should be routinely screened for aortic disease," says Dr. Miletic. "Certainly, if an athlete has a family history of aortic disease or sudden cardiac death, I recommend screening."

Aortic aneurysms don't usually have any early symptoms. In many cases, athletes find out they have one while getting screened for something else. "We're finding more aneurysms, because we're looking more," says Dr. Miletic. "We pick them up while doing other screenings, such as an echocardiogram, lung cancer screening or heart CT scan."

If you do have an aneurysm, your doctor will probably recommend follow-up screenings every 6 to 12 months to track its size and rate of growth. That way, they can see if it reaches a point where it requires surgical treatment.

Exercising Safely With Aortic Disease

Even if you are diagnosed with an aortic aneurysm, it doesn't have to signal the end of exercise. "People worry that an aneurysm is a ticking time bomb and that they shouldn't be doing anything that might set it off," says Dr. Miletic. "But that's not true. Exercising with an aortic aneurysm is possible, but it does require some precautions depending on the size and location of the aneurysm."

High blood pressure is one of the main risk factors that can lead to a ruptured aneurysm or aortic dissection. "We want people to exercise, because exercise is one of the best ways to help control high blood pressure," says Dr. Miletic.

Depending on the size of the aneurysm, your age and overall health, your doctor may put some restrictions on what types of exercise are safest. Very heavy weight lifting (lifting more than 50% of your body weight) can cause blood pressure spikes. And high-contact sports (like football or hockey) may put excess stress on the body.

"It's very important to work with a doctor who has a lot of experience diagnosing and treating aortic disease," says Dr. Miletic. "They'll be able to give you the individualized care and guidance you need."

Reviewed by Dr. Kyle Miletic, a cardiac surgeon and co-director of the Comprehensive Aortic Center at Henry Ford Hospital.