Anabolic Androgenic Steroids Induce Reversible Left Ventricular Hypertrophy and Cardiac Dysfunction. Echocardiography Results of the HAARLEM Study

Abstract

Background: The use of anabolic androgenic steroids (AAS) is not uncommon among strength athletes. Several cross-sectional studies have linked AAS use to heart disease, but a causal role for AAS is not certain and it is unknown whether cardiac changes are reversible.Methods: Men of at least 18 years old intending to start an AAS cycle on short notice were included for comprehensive 3D echocardiographic examination before (T0), at the end of the cycle (T1), and 1 year after inclusion (T2) after a recovery period. Details of the AAS cycle performed and the use of other performance and image-enhancing drugs (PIEDs) as well as illicit drug use were recorded. Trend analysis and multivariable regression analysis were performed with mixed effects linear models.Results: Thirty-one subjects were included. Between start (T0) and end of the cycle (T1), after a median AAS cycle duration of 16 weeks, 3D left ventricular ejection fraction declined with 4.9% (CI −7.2 to −2.5, P < 0.001), E/A-ratio declined with−0.45 (CI −0.69 to −0.21, P < 0.001), and 3D left atrial volume increased with 9.2 ml (CI 2.9–15.4, P = 0.004). Left ventricular mass increased with 28.3 g (CI 14.2–42.4, P < 0.001) and was positively correlated with AAS average weekly dose. After a median recovery time of 8 months (T2), all parameters returned to baseline.Conclusion: AAS induce left ventricular hypertrophy and impaired systolic and diastolic function in amateur strength athletes. The structural cardiac changes are positively associated with AAS dose and complete recovery occurred after AAS were discontinued.

Medaka embryos as a model for metabolism of anabolic steroids

“…Alternatively, sub-microscopic effects might have changed the anatomy of the developing heart during the 2-day exposition. In adult strength athletes, a 6-week AAS cycle reversibly increased the left ventricle mass and reduced the ejection volume by 5% (Smit et al 2021 ). In view of the fact that the analysis of detailed cardiotoxic effects was beyond the scope of this study, we cannot unambiguously define the elevated heart beat rate in 10 µM MD treated individuals as anabolic effect.…”

Anabolic–androgenic steroids: How do they work and what are the risks?

“…Long-standing untreated hypertension might exacerbate the detrimental effects of AAS on cardiac structure and function, perhaps making blood pressure treatment in this population particularly relevant. The HAARLEM study, however, found no interaction between blood pressure and echocardiographic parametersprobably because the increase was mild and of relatively short duration (97). Future research is necessary to explore the efficacy of blood pressure-lowering medication in this group of patients as no trial to date has evaluated this.…”

“…Thirty-one men enrolled in the HAARLEM study were subjected to 3D echocardiography before, at the end, and a median of 8 months after the start of their self-administered AAS cycles (97). The prospective nature, comprehensive evaluation and long follow-up make the results of this trial particularly interesting.…”

Health effects of androgen abuse: a review of the HAARLEM study

“…Measurements took place before, during and twice after the cycle. Health effects were divided into several categories: positive and negative adverse effects reported by the subjects, the results of kidney and liver biochemistry in blood, and the outcome of psychological questionnaires [4 ▪ ]; the disruption and recovery of endogenous testosterone production and spermatogenesis [5 ▪ ]; the change of cardiovascular parameters during androgen abuse, such as blood pressure, lipid metabolism and erythrocytosis [6 ▪ ]; and change of cardiac structure and function as evaluated with 3D echocardiography [7].…”

“…In the last 2−3 years several publications reported data from the HAARLEM study [3,4 ▪ –6 ▪ ,7], which is an acronym for health risks of anabolic androgenic steroid use by male amateur athletes. This cohort study takes precedence over much of the existing literature in this field due to its prospective design and relatively large size.…”