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Most professional athletes are by definition models of good health. But when pro-football linemen, with their towering builds and sometimes massive girth, lumber onto the field, many people understandably start to wonder: How can these trundling behemoths possibly be healthy?

As football players have exploded in strength and size over the past two decades — many players, who easily exceed the 300-pound mark, would technically qualify as obese — researchers and sports physicians have increasingly worried about their health. One study of about 6,850 former pro players conducted in 1994 by the National Institute for Occupational Safety and Health (NIOSH), at the behest of the National Football League Players Association, found that while former players had a lower death rate overall compared with their peers in the general population, the heaviest players — offensive and defensive linemen — were 52% more likely to die of heart disease. (Watch TIME's video "How to Lose Hundreds of Pounds.")

But now a new study of active players, funded by the National Football League (NFL), adds another wrinkle to the issue. In the spring of 2007, a panel of heart specialists collected extensive data on the cardiovascular health of 504 veteran members of 12 pro teams — representing about one-fourth of all nonrookie players in the league — and found that when it comes to their hearts, NFL players may be as healthy as men of the same age in the general population.

Researchers recorded players' height, weight, blood pressure, total cholesterol and self-reported health histories, and compared that data to an age- and race-matched sample from the Coronary Artery Risk Development in Young Adults study, a population-based study of more than 1,900 healthy men aged 23 to 35. Despite being nearly four inches taller and more than 60 pounds heavier on average than their nonplaying peers, NFL athletes had similar blood levels of cholesterol and triglyceride, and lower fasting-glucose levels (high fasting glucose is a common marker for diabetes). What's more, when examined by race, black NFL players showed no higher risk of heart disease than white players, even though black men in the general population have a much higher rate than their white peers. Overall, NFL players were also much less likely than other men to smoke cigarettes, another risk factor for heart disease and diabetes.(See the top 10 medical breakthroughs of 2008.)

It appears then, that current players' high level of physical fitness "more or less mitigates the effect of large size when it comes to cardiovascular risk," says Dr. Andrew Tucker, head physician for the Baltimore Ravens and co-author of the study, which was published in the May 27 issue of the Journal of the American Medical Association (JAMA).

The study did, however, raise one point of concern: compared with men in the general population, NFL players had higher rates of hypertension, a key risk factor for heart disease and stroke. That's no surprise; the bigger you are, the more likely your blood pressure will nudge higher, say researchers. But Tucker says the findings "really open our eyes to how important it is to monitor blood pressure," along with other factors that may contribute to cardiovascular health such as strength and resistance training, the use of nonsteroidal anti-inflammatory drugs and salt intake. Going forward, says Tucker, those behaviors will be studied in depth on a leaguewide basis.

Among the issues the new study does not further explore, however, is whether players are able to maintain their health after retirement. In addition to the 15-year-old NIOSH study, a 2008 report by the American Heart Association (AHA) concluded that compared with other men, retired players were more likely to have high cholesterol and impaired fasting glucose despite significantly lower rates of diabetes and hypertension. Although "remaining physically active may help protect against many of the health risks of large body size in former competitive football players," said Dr. Alice Chang, lead author of the AHA study and an assistant professor at the University of Texas Southwestern Medical School, in a statement at the time the findings were released, "being a professional athlete doesn't protect you from developing heart disease later in life." (Watch TIME's video "Uninsured Again.")

Still, there's little doubt that the NFL will use the new JAMA findings to bolster its stance in what has become an ugly battle over the treatment of former players. In recent years, several retired players have been denied disability compensation from the NFL for serious health conditions, including heart disease, which they attribute to their time playing football. While the NFL pays out about $1 billion in pensions and other benefits each year, it sets aside just $20 million annually to care for disabled retired players. Players' advocates say that allotment is too small to cover the injuries retired athletes suffer, and call for an overhaul of the notoriously cumbersome system that they must navigate to qualify for such benefits.

Ask Brent Boyd, a retired offensive guard for the Minnesota Vikings, who receives Social Security disability benefits for head trauma sustained while playing football, but was refused similar recompense from the NFL. Testifying in 2007 at a congressional hearing on NFL retirement benefits, Boyd described the NFL's process as "delay, deny and hope I put a bullet through my head to end the problem." Of the 8,000 living NFL retirees, slightly more than 300 receive disability benefits.

Tucker concedes that much remains to be learned about the health of retired players. He notes that current players are likely to be healthier than retirees in decades past, due to lower smoking rates and a 1983 ban on steroids. If anything, says Tucker, this latest research "puts us on the path of finding out just where problems surface — on or off the field." That's good news for both current and retired players.

Read "The Year in Medicine 2008: From A to Z."

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• Kathleen Kingsbury
• A new study of active NFL athletes suggests that despite their size and weight, their cardiovascular health is roughly on par with men in the general population