Fit but not immune from the risk: the hidden burden of dyslipidemia in elite athletes

Elite athletes are widely perceived to possess exceptional cardiovascular health due to their high levels of physical activity. However, emerging evidence suggests that among the established cardiovascular risk factors, dyslipidemia remains prevalent and frequently under-recognized in this population. Despite their athletic status, elite competitors, including Olympic and Paralympic athletes, may exhibit lipid abnormalities influenced by a complex interplay of factors such as sport type, training intensity, gender, ethnicity and disability status. This review aims to provide a comprehensive overview of dyslipidemia in elite athletes, exploring its prevalence, contributing physiological and lifestyle factors, clinical consequences and current approaches to assessment and management. Special attention is given to population-specific considerations, including gender, sport type and ethnicity. The limitations of general population cardiovascular risk scores in this context are discussed, with a focus on the need for athlete-specific tools such as the proposed "Lipid Athlete Score." Management strategies, ranging from lifestyle modification to the cautious use of pharmacologic agents and emerging nutraceutical interventions, are critically evaluated. Finally, the review highlights gaps in current research and outlines future directions, emphasizing the importance of tailored, evidence-based approaches to preserve cardiovascular health and athletic longevity in this unique population.