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There is consolidated evidence that physical activity exerts beneficial effects on several chronic conditions and longevity, on the basis of its proposed biological effects, especially on lipid profiles. However, debate continues regarding the intensity of activity required for good health, as vigorous physical activity might overwhelm advantageous changes. In addition, little is known so far on the effect of a vigorous and regular aerobic training regimen on emerging markers of cardiovascular risk, such as lipoprotein(a), total/high-density lipoprotein cholesterol ratio and the atherogenic index of plasma.To further investigate this topic, an extensive lipid profile, in accordance with the most recent guidelines issued by the American Heart Association (AHA)/American College of Cardiology (ACC) and the National Cholesterol Education Program (NCEP), was evaluated in 60 healthy male sedentary controls and in a wide population of professional endurance athletes, including 40 male professional cross-country skiers and 102 male professional road cyclists.Total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), triglycerides, TC low-density lipoprotein cholesterol (LDL-C) ratio and the atherogenic index of plasma were significantly lower in both categories of professional athletes, whereas the mean HDL-C concentration was significantly higher. The concentration of lipoprotein(a) did not differ significantly between the groups. When compared to current NCEP or AHA/ACC goals, the percentage of patients with undesirable values was statistically different for all parameters tested, apart from lipoprotein(a). According to multiple stepwise logistic regression analysis, lower TC/HDL-C ratio in professional skiers and lower TC/HDL-C ratio and TC in professional cyclists were significantly associated with increased aerobic physical activity.Results of this case-control study confirm that elevated aerobic energy expenditure might be associated with a highly favorable stabilization of most traditional and emerging cardiovascular risk predictors. Therefore, a substantial increase in aerobic physical activity within the population might be recommended to reverse adverse lipid abnormalities, especially in subjects with a higher cardiovascular risk.