Cardiovascular Toxicity of Illicit Anabolic-Androgenic Steroid Use

Circulation. 2017 May 23;135(21):1991-2002. doi: 10.1161/CIRCULATIONAHA.116.026945.

Abstract

Background: Millions of individuals have used illicit anabolic-androgenic steroids (AAS), but the long-term cardiovascular associations of these drugs remain incompletely understood.

Methods: Using a cross-sectional cohort design, we recruited 140 experienced male weightlifters 34 to 54 years of age, comprising 86 men reporting ≥2 years of cumulative lifetime AAS use and 54 nonusing men. Using transthoracic echocardiography and coronary computed tomography angiography, we assessed 3 primary outcome measures: left ventricular (LV) systolic function (left ventricular ejection fraction), LV diastolic function (early relaxation velocity), and coronary atherosclerosis (coronary artery plaque volume).

Results: Compared with nonusers, AAS users demonstrated relatively reduced LV systolic function (mean±SD left ventricular ejection fraction = 52±11% versus 63±8%; P<0.001) and diastolic function (early relaxation velocity = 9.3±2.4 cm/second versus 11.1±2.0 cm/second; P<0.001). Users currently taking AAS at the time of evaluation (N=58) showed significantly reduced LV systolic (left ventricular ejection fraction = 49±10% versus 58±10%; P<0.001) and diastolic function (early relaxation velocity = 8.9±2.4 cm/second versus 10.1±2.4 cm/second; P=0.035) compared with users currently off-drug (N=28). In addition, AAS users demonstrated higher coronary artery plaque volume than nonusers (median [interquartile range] 3 [0, 174] mL3 versus 0 [0, 69] mL3; P=0.012). Lifetime AAS dose was strongly associated with coronary atherosclerotic burden (increase [95% confidence interval] in rank of plaque volume for each 10-year increase in cumulative duration of AAS use: 0.60 SD units [0.16-1.03 SD units]; P=0.008).

Conclusions: Long-term AAS use appears to be associated with myocardial dysfunction and accelerated coronary atherosclerosis. These forms of AAS-associated adverse cardiovascular phenotypes may represent a previously underrecognized public-health problem.

Keywords: anabolic-androgenic steroids; atherosclerosis; cardiology; cardiomyopathy; diastolic dysfunction; men.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Androgens / adverse effects*
  • Cardiotoxicity
  • Case-Control Studies
  • Computed Tomography Angiography
  • Coronary Angiography / methods
  • Coronary Artery Disease / chemically induced*
  • Coronary Artery Disease / diagnostic imaging
  • Coronary Artery Disease / pathology
  • Coronary Vessels / diagnostic imaging
  • Coronary Vessels / drug effects*
  • Coronary Vessels / pathology
  • Cross-Sectional Studies
  • Diastole
  • Doping in Sports*
  • Echocardiography
  • Humans
  • Male
  • Middle Aged
  • Multidetector Computed Tomography
  • Performance-Enhancing Substances / adverse effects*
  • Plaque, Atherosclerotic
  • Risk Assessment
  • Risk Factors
  • Stroke Volume / drug effects
  • Substance-Related Disorders / complications*
  • Systole
  • Testosterone Congeners / adverse effects*
  • Time Factors
  • Ventricular Dysfunction, Left / chemically induced*
  • Ventricular Dysfunction, Left / diagnostic imaging
  • Ventricular Dysfunction, Left / physiopathology
  • Ventricular Function, Left / drug effects*
  • Weight Lifting*

Substances

  • Androgens
  • Performance-Enhancing Substances
  • Testosterone Congeners