Objective: Olympic athletes (OAs) represent a unique subset of highly trained subjects achieving extraordinary performance. Differences between OAs and elite/national athletes (EAs), defined as athletes not qualified for the Olympics, are not investigated. Design: Therefore, we compared OAs with EAs enrolling 1472 athletes (63.6% OAs; 56.9%, men, mean age 25.8 ± 5.1 years) of power (24.7%), skills (12.5%), endurance (20.8%), and mixed (37.4%) disciplines performing clinical, anthropometric, echocardiographic, exercise stress, and blood test analysis. Results: Olympic athletes were older (power: 25.9 ± 4.6 vs 24.1 ± 4.7, P = 0.0002; skills: 28.6 ± 6.5 vs 25.2 ± 6.5, P = 0.0003; endurance: 27.2 ± 4.5 vs 23.7 ± 3.9, P = 0.001; mixed: 27.9 ± 4.7 vs 22.8 ± 4.4, P = 0.001) and trained for more hours (power: 26.1 ± 10.9 vs 19.9 ± 7.5, P < 0.0001; skills: 29.1 ± 9.4 vs 21 ± 9.4, P = 0.0004; endurance: 26.4 ± 8.7 vs 19.4 ± 8.5, P = 0.001; mixed: 28.4 ± 9.5 vs 22.2 ± 9.2, P = 0.001) compared with EAs. No morphological cardiac differences were observed. At the exercise test, the maximum watt reached was similar (except that in power, P = 0.004). Olympic athletes showed statistically significant lower serum calcium, lower thyroid stimulating hormone, and relatively higher total and low-density lipoprotein cholesterol. Conclusions: Olympic athletes are older, have a larger body mass, and can sustain a larger training volume than elite athletes. However, no major differences in cardiac remodeling or clinical and laboratory parameters differentiate these 2 groups. Expertise and volume of training appear to represent the critical factors to translate from the national to the Olympic level.
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