Cardiovascular risk in recreational runners: a scoping review of screening and risk assessment

Abstract Aim Running has increased worldwide and is widely recognized as cardioprotective. However, less is known about how cardiovascular risk is assessed among runners and whether current screening strategies are adequate for large-scale application. Subject and methods This scoping review aimed to map and synthesize the available evidence on cardiovascular risk in recreational runners, with a specific focus on screening approaches and risk assessment methods. The review followed the Joanna Briggs Institute framework and was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. Searches were conducted in PubMed/MEDLINE, Scopus, SPORTDiscus, Web of Science, SciELO, and the Virtual Health Library (including LILACS). Observational and clinical studies involving adult runners that assessed cardiovascular risk, screening strategies, or acute cardiovascular events were included. Data were synthesized descriptively. Results Thirteen studies were included, which were predominantly observational and conducted in North America and Europe. Cardiovascular risk assessment was primarily based on self-reported questionnaires and general population risk models, with fewer studies incorporating clinical, laboratory, or functional evaluations. Approaches varied substantially and were rarely integrated. Although running was associated with lower cardiovascular and all-cause mortality, and acute events were infrequent, a proportion of runners presented elevated or uncontrolled risk factors. Conclusion Importantly, no standardized, low-cost, and population-based screening tool specifically designed for runners was identified. This gap limits the implementation of large-scale preventive strategies and highlights the need for accessible and sport-specific approaches to cardiovascular risk assessment in this growing population. Key Points • Recreational running is consistently associated with lower cardiovascular and all-cause mortality, particularly when individuals transition from sedentary behavior to regular practice. • Acute cardiovascular events during running are rare but occur predominantly in middle-aged men with underlying, often undiagnosed, coronary artery disease. • Cardiovascular risk assessment in runners is predominantly based on self-reported questionnaires and general population risk models, with limited use of integrated clinical and functional approaches. • Current screening strategies are heterogeneous and not specifically designed for runners, which may limit their ability to accurately identify risk in this population. • No standardized, low-cost, and population-based screening tool tailored to recreational runners was identified, limiting large-scale prevention and epidemiological monitoring.