In a perfect world for the older athlete (35-40+) that want to still push things a bit I would recommend the below:
Age 35: Stress Echo to make sure EF is good and there's no signs of LVH. Repeat this every 5 years or so
Age 45: Calcium Scan Score to check for any hard plaque
Age 50: CMIT: Look at the carotid to check for narrowing (these are non invasive and cheap)
Age 55: CT Angiogram with contrast to check for both hard and soft plaque
Supplements:
Ubiquinol: 400-600mg/day
Nattokinase: 10,000fu/day
Fish Oil: 2-4g of high DHA & EPA
Krill Oil: 6g/day
Allicin Garlic: 1,000mh/day
Arjuna: 750mg/day
Taurine: 3-4g/day
Ribose: 10g/day
Aspirin: 81mg/day
Pharma Supps:
Telmisartan 40mg/day
Cialis: 5mg/day
Crestor or statin: as needed (I microdose 5mg Crestor 2x/week)
*if you are against statins, then use 1200mg daily Jarrow Red Yeast Rice
Notes
-These are in addition to a well rounded supplement protocol with supplements that keep systematic inflammation low.
-Baby aspirin should only be used by those with no stomach/GI issues. Contrary to the science whenever I've had to go off aspirin for a surgery for an extended period, my hematocrit will rise even while on a TRT dose.
-Routine bloodwork should be taken 4-6x a year including regularly checking "extras" such as HS-CRP, cystitis C, APO B, Lipoprotein (a), NMR particle test, fasted insulin, A1c, etc.
-Keep blood pressure as close to 120/80 as possible
-Get tested for the clotting disorders