Retired NFL players, notably linemen, have high risk of artery plaque, independent study shows
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Retired NFL players may have a high risk of undiagnosed, untreated coronary artery disease (CAD) that often occurs without symptoms, according to new, independent, preliminary research presented at the American Heart Association's Scientific Sessions 2026, held Nov. 6–9 in Chicago.
CAD occurs when cholesterol plaque deposits in the heart arteries, limiting blood flow to the heart and reducing oxygen delivery. Plaque buildup can lead to a heart attack.
"Nearly 9 out of 10 men in this study had plaque in their coronary arteries, 4 in 10 had a significant narrowing, and yet almost none of them experienced any symptoms, and prior to the scan less than a third were on statins to lower their cholesterol," said study co-author Campbell Rogers, M.D., chief medical officer at Heartflow Inc., a medical technology company advancing noninvasive heart disease diagnosis through artificial intelligence.
"These results are consistent with the fact that 1 in 3 former NFL players dies from heart disease."
This study is believed to be the first assessment of coronary plaque in retired professional football players. It focused on 200 retired NFL players enrolled in the GAMEFILM Registry who underwent coronary computed tomography angiography (CCTA) and Heartflow AI coronary plaque analysis (AI-CPA). The AI analysis creates a personalized, color-coded 3D model of heart arteries and measures plaque volume, type and impact on blood flow.
Key findings:
- The imaging revealed coronary plaque in 85% of former players, yet only 13% had a known CAD diagnosis prior to the scan.
- Coronary artery disease was often advanced among the retired players: 42% of former players had a blockage that narrowed at least one of their heart arteries by more than 50%. About 1 in 5 had blockages in multiple arteries, or 29% had plaque substantial enough to significantly restrict blood flow to the heart. However, fewer than 10% of the former players reported chest pain or shortness of breath.
- On average, nearly 90% of the detected plaque was soft (noncalcified), which is associated with higher disease risk than calcified plaque and cannot be detected by traditional coronary artery calcium scores. One in 3 former NFL players had coronary plaque, placing them in the severe or extensive category of total plaque volume (TPV 251–750 mm³ or TPV >750 mm³, respectively).
- Retired linemen had more plaque and more severe blockages compared with participants who had played other positions.
- Researchers compared total plaque volume for each participant to an age- and sex-matched group of individuals, and former linemen sat above the median for total plaque volume, while players of other positions ranked well below the median—a statistically significant difference.
"We expected to find plaque, but we did not expect to find such a striking gap between how much significant disease these former football players had and how few of them had any symptoms," Rogers said. "It is a reminder of how poorly symptoms can track with what is actually happening inside a coronary artery."
Lead study author David Maron, M.D., a paid consultant for Heartflow, noted that what is encouraging about the study is that participants were eager to take preventive action.
"When participants could see the plaque in their arteries, they wanted to act—nearly 90% of those not already taking cholesterol-lowering medications before the analysis said they were ready to start treatment," Maron said. "The good news is that when CAD is found early, it is very treatable, often with medication and lifestyle changes rather than a medical procedure."
He said the next steps in research are to explore whether willingness to act leads to treatment, lower cholesterol levels and fewer heart attacks.
Maron is the chief of the Stanford Prevention Research Center at Stanford University; however, this research work was not part of his Stanford University duties or responsibilities.
American Heart Association volunteer expert Michael Shapiro, M.D., MPH, FAHA, said that being a former elite athlete does not protect you from coronary disease later in life.
"Plaque can build up in the artery walls for years without affecting blood flow enough to cause symptoms," he said. "So, feeling fine does not necessarily mean the arteries are healthy. A plaque can also rupture and cause a clot and heart attack without much warning."
Shapiro, who was not involved in the study, is chair of the association's ATVB & Lifestyle Clinical Lipidology, Lipoprotein, Metabolism & Thrombosis Committee.
While this study focused on former athletes, he noted that there is a message to the public.
"Everyone should pay attention to risk before symptoms appear," said Shapiro, who is also director of the Center for Prevention of Cardiovascular Disease at Wake Forest University School of Medicine in Winston-Salem, North Carolina. "You need to know your cholesterol, blood pressure and family history, and get treatment when it is needed."
Study details, background, design and limitations:
- The GAMEFILM Registry is a heart-health study for retired professional athletes that began with former NFL players and now includes former NHL, MLB and NBA players, as well as professional athletic staff associated with these leagues or U.S. college sports teams.
- The median age of participants in this study was 57 years, and the median body mass index (BMI) was 31.
- Among the participants: About a quarter were linemen; 5% had type 2 diabetes; about 30% had high blood pressure and/or high cholesterol; and 1 in 6 self-reported that they were current or former smokers.
- The CCTA used in the research is a noninvasive X-ray angiogram of the heart's arteries to visualize whether heart artery narrowing is present. Researchers ran those images through the Heartflow AI coronary plaque analysis tool, then each participant reviewed his results with a cardiologist. Before and after that conversation, each former player was asked whether he believed he had heart disease and whether he would be willing to begin treatment, possibly including one or more medications.
- Heartflow is a medical technology company that uses AI-powered software to diagnose and manage CAD noninvasively.
- The research has several limitations, including that it is based on voluntary enrollment; therefore, the participants in the study do not represent all retired NFL players. It also did not have a prospectively enrolled control group of nonathletes. Researchers compared the participants to an age- and sex-matched reference population of athletes. Because the study examined former NFL players, the findings may not be applicable to other athletes or the general population.
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Sadie Harley
BSc Life Sciences & Ecology. Microbiology lab background with pharmaceutical news experience in oil, gas, and renewable industries. Full profile →
Andrew Zinin
Master's in physics with research experience. Long-time science news enthusiast. Plays key role in Science X's editorial success. Full profile →
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