Effects of dyslipidemia on endothelial morpho-functional parameters in a cohort of elite athletes practicing different sporting disciplines
Authors: Di Gioia G , Maestrini V , Monosilio S , Lemme E , Squeo M R , Serdoz A , Zampaglione D , Fiore R , Paoletti G , Pelliccia A 
Published: June 2024

Abstract

Introduction
Athletes are supposed to have low global cardiovascular risk profile. Dyslipidemia is usually underestimated and undertreated in this population since the lack of evidence of effects on early endothelial dysfunction.

Objective
To evaluate the effects of dyslipidemia on early endothelial morpho-functional parameters (carotid intima-media thickness, IMT and brachial flow-mediated dilation, FMD) in elite athletes.

Materials and Methods
We enrolled 104 elite athletes that participated at 2023 Krakow European Games. We excluded athletes younger than 25 years old and those on chronic lowering-lipid agents. Dyslipidemia was defined as LDL &gt;115 mg/dL. Carotid ultrasound with IMT measurement and brachial FMD were performed. FMD normal value was defined as &gt;10%.

Results
Athletes (53% male) were divided according to sport discipline into: 18% power, 29% skills, 33% endurance and 20% mixed. Mean age was 30.1±4. Females had better lipid profile (higher HDL, p=0.0005 and lower LDL/HDL, p&lt;0.0001) compared to men. Also LDL were lower (p=0.062); no differences were highlighted in total cholesterol and triglycerides.
No gender differences were found in IMT (0.60±0.06 mm in male vs. 0.58±0.06 in female, p=0.271) and FMD (10.03±11.48% in male vs. 12.94±11.1% in female, p=0.177).
Globally, 19.2% were dyslipidemic; 13\55 (23.6%) in males, 7\49 (14.3%) in females, p=0.221.
In dyslipidemic males, FMD was lower (3.7±11.5%) compared to those with normal lipid profile (11.98±10.7%), p=0.023. IMT was similar, even if dyslipidemic had higher values (0.61±0.06 mm vs. 0.59±0.06 mm, p=0.263). In female athletes, no differences were found between dyslipidemic and control group for both FMD (p = 0.339) and IMT (p = 0.239).
Males with FMD &lt;10% showed significantly higher carotid IMT (0.61±0.06 mm vs. 0.58±0.06 mm of control group, p=0.023). Linear regression analysis between IMT and FMD in males showed significant negative correlation (p=0.039; R2=0.076). In females, no significant difference in LDL (p=0.972) and IMT (p=0.449) were found between those with FMD &lt;10% and control group. Also, linear regression analysis in females showed no correlation between IMT and FMD (p=0.712; R2=0.002).
Type of sporting discipline practiced did not to influenced morpho-functional parameters with similar IMT (p=0.667) and FMD (p=0.276) among different sporting disciplines.

Conclusions
Significant gender differences in lipid profile exist with better lipid profile in female athletes. Prevalence of dyslipidemia in athletes reaches 19.2% in overall population. In males, a significant influence of lipid alterations on brachial index parameters was demonstrated, indicating early sign of endothelial dysfunction. In conclusion, dyslipidemia especially in male athletes, should not be underestimated and early correction is suggested to reduce the risk of future development of atherosclerotic disease. Regression analysis between IMT and FMD.