Retired NFL players, particularly linemen, may be at high risk of undiagnosed and untreated coronary artery disease (CAD) that often occurs without symptoms, according to preliminary research presented at the American Heart Association's Scientific Sessions 2026 in Chicago. The study, believed to be the first assessment of coronary plaque in retired professional football players, examined 200 former NFL players enrolled in the GAMEFILM Registry who underwent coronary computed tomography angiography (CCTA) and Heartflow AI coronary plaque analysis (AI-CPA).
The imaging revealed coronary plaque in 85% of former players, yet only 13% had a known CAD diagnosis prior to the scan. CAD occurs when cholesterol plaque deposits in the heart arteries, limiting blood flow and reducing oxygen delivery, which can lead to a heart attack. The disease was often advanced: 42% of former players had a blockage narrowing at least one heart artery by more than 50%, about 1 in 5 had blockages in multiple arteries, and 29% had plaque substantial enough to significantly restrict blood flow. However, less than 10% reported chest pain or shortness of breath. On average, nearly 90% of 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.
Retired linemen had more plaque and more severe blockages compared with participants who played other positions. When researchers compared total plaque volume for each participant to an age- and sex-matched group, former linemen sat above the median for total plaque volume, while players of other positions ranked well below the median—a statistically significant difference. One in three former NFL players had coronary plaque placing them in the severe or extensive category of total plaque volume.
"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," said study co-author Campbell Rogers, M.D., chief medical officer at Heartflow, Inc. "It is a reminder of how poorly symptoms can track with what is actually happening inside a coronary artery." Rogers noted that 1 in 3 former NFL players dies from heart disease.
Lead study author David Maron, M.D., a paid consultant for Heartflow and chief of the Stanford Prevention Research Center at Stanford University, said 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." The next steps in research are to explore whether willingness to act translates into treatment, lower cholesterol levels and fewer heart attacks.
American Heart Association volunteer expert Michael Shapiro, M.D., MPH, FAHA, who was not involved in the study, emphasized that being a former elite athlete does not protect against coronary disease later in life. "Plaque can build up in the artery walls for years without affecting blood flow enough to cause symptoms," Shapiro 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." He added that everyone should pay attention to risk before symptoms appear by knowing cholesterol, blood pressure and family history, and seeking treatment when needed.
The research has limitations, including voluntary enrollment, meaning participants do not represent all retired NFL players, and the absence of a prospectively enrolled control group of non-athletes. The findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal. The study's implications extend beyond former athletes, underscoring the importance of early cardiovascular risk assessment. As the American Heart Association notes in related research, More than 40% of adults with no known heart disease had fatty deposits in heart arteries, and Study found artery damage in adults in their 20s, highlighting need for early cardiovascular risk assessment. The Association also recently issued updated guidance: ACC/American Heart Association Issue Updated Guideline for Managing Lipids, Cholesterol. More information is available at heart.org and stroke.org.
