Clinical Considerations for Competitive Sports Participation for Athletes With Cardiovascular Abnormalities: A Scientific Statement From the American Heart Association and American College of Cardiology
In February 2025, the American Heart Association and the College of Cardiology issued revised Athlete Guidelines for Competitive Sports (the “Guidelines”). The Guidelines are medically complex and addresses aortic disease. A glossary of acronyms can be found here.
The Guidelines underscore the importance of shared decision-making, individualized risk assessment, and considerations of the specific sport’s demand when advising athletes with cardiovascular abnormalities. This approach aims to balance the benefits of sports participation with the potential risks associated with underlying heart conditions.
The considerations in the Guidelines apply to all individuals that participate in organized team or individual sports that require regular competition, place a high premium on achievement and require some form of systematic and intense training. It also applies to athletes participating in high-level recreational sports (e.g., marathon runners, triathletes, cyclists and Cross Fit enthusiasts).
The Guidelines reflect a shift from blanket restrictions to a more nuanced approach, allowing many athletes with aortic conditions to safely participate in sports under appropriate medical supervision. It highlights new evidence suggesting that many athletes with cardiovascular conditions can safely complete, depending on the type of sport and individual risk. Competitive sports are looked on a continuum of endurance and strength physiological components reflecting a move away from prescriptive limitations to shared decision making between athletes and healthcare professionals based on the type of sport and individual risk factors.
Here is a simplified view of the competitive athlete sports participation guidelines for individuals with aortic disease during the “Watch & Wait” phase:
Here is a simplified view of competitive athlete participation post aortic repair:
