Cardiovascular Effects Associated with the Female Athlete Triad: Emerging Evidence Statement from the Female and Male Athlete Triad Coalition

Abstract This is an emerging evidence statement from the Female and Male Athlete Triad Coalition. This paper complements the 2025 updates to the Female Athlete Triad Coalition Consensus Statements addressing the State of the Science and Clinical Guidelines for Screening, Diagnosis, Treatment and Return to Play. This paper examines emerging evidence of cardiovascular alterations in Triad-affected female athletes with functional hypothalamic amenorrhea and functional hypothalamic oligomenorrhea, including vascular, hemodynamic, autonomic and lipid perturbations. The clinical significance of these surrogate markers of cardiovascular function and their long-term cardiovascular implications remain to be determined. Notwithstanding, the current work extends existing Triad frameworks by recognizing cardiovascular perturbations potentially associated with energy deficiency and hypoestrogenism as an important consideration in female athlete health. We outline an evidence-informed research framework, including longitudinal, dose–response, and multimodal assessments, to characterize the onset, magnitude, physiological significance, and reversibility of cardiovascular alterations in athletes with functional hypothalamic amenorrhea and functional hypothalamic oligomenorrhea. By integrating evidence from sports physiology, endocrinology, and cardiovascular medicine, this state-of-the-science synthesis provides a roadmap for future research, screening, and intervention strategies. It also underscores the importance of evaluating cardiovascular health as a potential component of the broader physiological consequences of energy deficiency, alongside menstrual dysfunction, and impaired bone health.