As recently posted by Aortic Athlete Julian Meldrum, in February 2025, the American Heart Association and the College of Cardiology issued new, revised Clinical Considerations for Competitive Sports Participation for Athletes With Cardiovascular Abnormalities. And they have some application to Aortic Athletes!
The standards have been revised every five years over the last forty years as new clinical studies and medical practices become available.
They apply broadly to anyone participating in competitive sports, from children to masters athletes. (See the diagram ranking the strength and endurance needed to participate in various sports.)
And they apply to high-level recreational sports, including marathon runners, triathletes, cyclists, and CrossFit enthusiasts.
Today, we’ll talk generally about the standards. In the coming weeks, we’ll discuss Section VII on aortopathy including bicuspid aortas, and Section X on masters athletes (older than 35 years old!), including those with aortic disease.
The task force was made up of international experts in cardiology and exercise, including two friends of Aortic Athletes: Dr. Allen Braverman of Washington University in St. Louis and Dr. Tim Churchill of Harvard.
You can find links to our interviews with them below, and we hope to again interview them on these new standards.
One Major Change: A Focus on Joint Decision-Making
In the past, the medical community believed that athletes lacked the ability to make rational and informed decisions and should not have their own values included in the process of determining sports eligibility.
Today, clinicians are moving away from that “paternalistic decision-making” toward a more nuanced deliberation that provides options to practitioners and athletes.
The shift is away from “disqualification recommendations” to clinical considerations that should guide the decision-making process for doctors and athletes.
This doesn’t mean that all exercise or athletic events are safe for people with various kinds and stages of aortic disease. As Dr. Prakash said in our recent Aortic Athletes interview, the goal should be for doctors to find ways to help patients adapt to safely do the things they want to do, given their aortic disease.
Personal Note
When I first discussed with my health care providers my goal of running the New York Marathon in 2023, two years post my aortic dissection, my nurse practitioner was skeptical (“Why on earth would you want to do that?”).
My cardiologist, however, was encouraging once she learned my history as a retired Ironman with a plan to slowly increase mileage at a jogging pace. With my medically managed descending dissection stable, well-managed BP, and a ruled-out exercise hypertension through an echo stress test, she supported my decision.
Stay tuned next week for more on the standards.
Helpful Resources
