The Cardiovascular Disease Risk Indicators Linked With Low Energy Availability in Physically Active Females: A Systematic Review

Pope, Liam and Roche, Denise M and Marshall, Zoe A and Alwan, Nura and Webb, Richard J (2025) The Cardiovascular Disease Risk Indicators Linked With Low Energy Availability in Physically Active Females: A Systematic Review. Women in Sport and Physical Activity Journal, 33. ISSN 1063-6161

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Abstract

Objective: To systematically review the literature on cardiovascular disease (CVD) risk indicators linked with low energy availability (LEA) in physically active females. Design: The Cochrane Collaboration Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol was used to capture articles related to CVD risk indicators linked with LEA in physically active females. Methods: A search of PubMed, SportDiscus (EBSCOhost), One Search, and Google Scholar was performed. Results: Nine studies were included. Eight studies were rated fair, and one study was of good quality. Most studies found no significant effect of LEA on lipid levels, except for one study which identified abnormal lipid levels. Physically active females with LEA had significantly lower levels of phosphatidylethanolamine (p = .030) and exhibited distinct triglyceride trajectories, including acute exercise-induced fluctuations in those with amenorrhea, a steady increase in those with functional hypothalamic amenorrhea, and varying patterns based on energy availability (False Discovery Rate-adjusted p value < .050). With regards to the impact of LEA on direct vascular indices, one study found no significant difference in brachial artery flow-mediated dilation, pulse wave velocity, carotid intima–media thickness, or carotid artery reactivity between elite long-distance runners and inactive women. Whereas, another study reported significantly reduced flow-mediated dilation (p = .016) in elite dancers with LEA. Higher energy availability had no link to heart rate variability, and LEA was significantly associated with 2.5-fold increased CVD risk (p = .001). Conclusion: LEA may elevate CVD risks in physically active females. However, larger scale longitudinal studies with robust study designs (e.g., blood biomarkers and vascular assessments) are necessary to validate these implications.

Item Type:	Article
Additional Information and Comments:	Accepted author manuscript version reprinted, by permission, from Women in Sport and Physical Activity Journal, 2025, 33 (1): https://doi.org/10.1123/wspaj.2024-0115 © Human Kinetics, Inc.
Faculty / Department:	Faculty of Human and Digital Sciences > School of Health and Sport Sciences
SWORD Depositor:	eprints api
Depositing User:	eprints api
Date Deposited:	28 Jul 2025 09:02
Last Modified:	28 Jul 2025 09:02
URI:	https://hira.hope.ac.uk/id/eprint/4718

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