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Background: Cardiovascular disease (CVD) is the leading cause of death worldwide, but prevalence estimates in former professional athletes are limited., Objectives: HUDDLE (Heart Health: Understanding and Diagnosing Disease by Leveraging Echocardiograms) aimed to raise awareness and estimate the prevalence of CVD and associated risk factors among members of the National Football League (NFL) Alumni Association and their families through education and screening events., Methods: HUDDLE was a multicity, cross-sectional study of NFL alumni and family members aged 50 years and older. Subjects reported their health history and participated in CVD education and screening (blood pressure, electrocardiogram, and transthoracic echocardiogram [TTE] assessments). Phone follow-up by investigators occurred 30 days postscreening to review results and recommendations. This analysis focuses on former NFL athletes., Results: Of 498 participants screened, 57.2% (N = 285) were former NFL players, the majority of whom were African American (67.6%). The prevalence of hypertension among NFL alumni was estimated to be 89.8%, though only 37.5% reported a history of hypertension. Of 285 evaluable participants, 61.8% had structural cardiac abnormalities by TTE. Multivariable analysis showed that hypertension was a significant predictor of clinically relevant structural abnormalities on TTE., Conclusions: HUDDLE identified a large discrepancy between participant self-awareness and actual prevalence of CVD and risk factors, highlighting a significant opportunity for population health interventions. Structural cardiac abnormalities were observed in most participants and were independently predicted by hypertension, affirming the role of TTE for CVD screening in this population aged older than 50 years. (Heart Health: Understanding and Diagnosing Disease by Leveraging Echocardiograms [HUDDLE]; NCT05009589)., Competing Interests: Funding Support and Author Disclosures The HUDDLE trial was sponsored by Edwards Lifesciences, Irvine, California, USA. Drs Okoh and Amponsah have received consulting fees from Edwards Lifesciences. Dr Patel is a proctor for Edwards Lifesciences. Dr Brennan is the team physician for the NFL Tampa Bay Buccaneers. Dr Park is an employee of Edwards Lifesciences. Dr Gunnarsson is an employee of Edwards Lifesciences. Dr Snowden is an employee of Edwards Lifesciences. Dr Mootz is an employee of Edwards Lifesciences. Dr Koepnick is an employee of Edwards Lifesciences. Dr Wheeler is an employee of Edwards Lifesciences. Dr Clarke is an employee of Edwards Lifesciences. Dr Prince is an employee of Edwards Lifesciences. Dr Sannino has received research grants from CardioMech, Cardiovalve, Edwards Lifesciences (including the core lab contract for this study), and Restore Medical. Dr Grayburn has received research grants from Abbott Vascular, CardioMech, Cardiovalve, Edwards Lifesciences (including the core lab contract for this study), Medtronic, Neochord, Restore Medical, and 4C Medical; and has served on the Advisory Board as a consultant for Abbott Vascular, Edwards Lifesciences, Medtronic, and 4C Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)