Male athletes (n = 2026) that had represented Finland in international events from 1920 to 1965 and 1401 control subjects that had been classified healthy at the age of 20 years participated in this population-based cohort study. The main outcome measures were reimbursable medications for hypertension, cardiac insufficiency, coronary heart disease, diabetes, and asthma identified from the national registry from 1970 to 1998 as well as the use of NSAIDs, antacids and specific vitamin and mineral supplements for at least 60 days during the past year reported by questionnaire in 1985. Among former top-level athletes, the probability of initiating medication was decreased for cardiac insufficiency, coronary heart disease and asthma compared with controls. Furthermore, the risk of initiation of treatment with regular medication for hypertension and diabetes was reduced for endurance athletes but not for power athletes. In 1985, compared with control subjects, athletes used fewer NSAIDs and antacids but more vitamin A, B and C, selenium and iron supplements.