A preliminary study of 200 retired NFL players has revealed that many may be living with undiagnosed and untreated coronary artery disease (CAD), often without any symptoms. The research, presented at the American Heart Association’s Scientific Sessions 2026, is believed to be the first assessment of coronary plaque in retired professional football players and highlights a striking gap between the amount of disease present and the lack of warning signs.
CAD occurs when cholesterol plaque builds up in the heart’s arteries, limiting blood flow and oxygen delivery to the heart muscle, which can lead to a heart attack. Using coronary computed tomography angiography (CCTA) and Heartflow AI coronary plaque analysis (AI-CPA), researchers found that 85% of the former players had coronary plaque, yet only 13% had a known CAD diagnosis before the scan. More than 40% had a blockage narrowing at least one artery by more than 50%, and nearly 30% had plaque substantial enough to significantly restrict blood flow. Despite these findings, fewer than 10% reported chest pain or shortness of breath.
“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,” said study co-author Campbell Rogers, M.D., chief medical officer at Heartflow, Inc. “These results are consistent with the fact that 1 in 3 former NFL players dies from heart disease.”
The study focused on retired linemen, who had more plaque and more severe blockages compared with players at other positions. When compared to an age- and sex-matched reference group, former linemen sat above the median for total plaque volume, while other players ranked well below the median—a statistically significant difference. On average, nearly 90% of the detected plaque was soft (noncalcified), which is associated with higher disease risk and cannot be detected by traditional coronary artery calcium scores.
“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.”
The findings carry broader implications for the public, not just former athletes. Michael Shapiro, M.D., MPH, FAHA, a volunteer expert for the American Heart Association who was not involved in the study, emphasized that feeling fine does not guarantee healthy arteries. “Plaque can build up in the artery walls for years without affecting blood flow enough to cause symptoms,” he said. “A plaque can also rupture and cause a clot and heart attack without much warning.” He added that everyone should know their cholesterol, blood pressure and family history, and seek treatment when needed.
Encouragingly, the study found that when participants saw their plaque through the AI-generated 3D model, nearly 90% of those not already on cholesterol-lowering medications said they were ready to start treatment. “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,” said lead author David Maron, M.D. The research underscores the importance of early detection and risk assessment, aligning with prior American Heart Association findings, such as Study found artery damage in adults in their 20s, highlighting need for early cardiovascular risk assessment and More than 40% of adults with no known heart disease had fatty deposits in heart arteries.
The study’s limitations include voluntary enrollment and the lack of a prospectively enrolled control group of non-athletes, meaning the findings may not be generalizable to all retired NFL players or the general public. The abstract is available for review, and the research is considered preliminary until published in a peer-reviewed journal. The American Heart Association maintains strict policies to prevent donations from influencing its science, with overall financial information available here.
