Anabolic Steroids and Cardiovascular Outcomes: The Controversy

Abstract

Anabolic steroids (AS) are synthetic derivatives of the male sex hormone testosterone. The use of AS is not limited to bodybuilders and athletes, but non-athletes also use them. It is used to enhance athletic performance, induce muscle hypertrophy, and augment male sexual characteristics. AS use is associated with a wide range of side effects and potential cardiovascular complications. In this article, we have searched the available literature to investigate the association between AS use and cardiovascular disease (CVD). The results revealed that AS was linked to lipid metabolism derangements, hypertension, coagulation disorders, and cardiomyopathy. We concluded, based on the relevant data, that there was evidence that suggests an association with CVD, primarily myocardial infarction, fatal arrhythmias, and cardiomyopathy in AS users. The general population should be informed of the risk. Also, methods of primary and secondary prevention should be implemented to mitigate the risk of CVD secondary to AS.

Associations between legal performance-enhancing substance use and future cardiovascular disease risk factors in young adults: A prospective cohort study

“…For instance, 15-60% of nutritional supplements were found to contain AAS when tested [35,36]. A recent review found a link between AAS and CVD risk factors, including hypertension or dyslipidemia, in seven of the nine studies reviewed [37], consistent with prior reviews [38][39][40][41]. Potential mechanisms underlying this link include increased systemic inflammation, oxidative stress, and vascular dysfunction [41].…”

“…In sum, although preliminary research points to a prospective link between legal PES use and severe medical complications, there is a need to investigate long-term, prospective associations with specific health outcomes. In the present study, we focus on CVD risk factorsincluding diabetes, hypertension, abnormal lipid profiles, and obesity-in young adulthood given that these outcomes may take many years to fully manifest [38,42] and evidence suggesting that use of illegal PES (e.g., AAS) is associated with CVD risk factors [37][38][39][40][41]. Additionally, previous studies have been limited by small and/or highly specific samples (e.g., athletes) or comparison groups (e.g., vitamin users), warranting further evidence that large sample, population-based cohort studies are needed.…”

The Cardiac Effects of Performance-Enhancing Medications: Caffeine vs. Anabolic Androgenic Steroids

“…It also includes a direct effect on cardiac muscle metabolism, altering both electrical and structural features of the myocardium [ 44 ]. Supraphysiological doses of AASs induces toxicity of the CVS, with the proposed mechanisms including changes in the lipid profile, elevations in blood pressure, myocyte hypertrophy, disarray and apoptosis and a procoagulant state [ 45 ]. Thereby, contributing to disorders such coronary artery disease (CAD), hypertension, cardiomyopathy and thromboembolic disorders ( Figure 2 ); the above findings have been correlated with histopathological case reports [ 46 , 47 ].…”

The Cardiac Effects of Performance-Enhancing Medications: Caffeine vs. Anabolic Steroids

“…It also includes a direct effect on cardiac muscle metabolism, altering both electrical and structural features of the myocardium [30]. Supraphysiological doses of anabolic steroids induces toxicity of the cardiovascular system, with the proposed mechanisms including changes in the lipid profile, elevations in blood pressure, myocyte hypertrophy, disarray and apoptosis and a procoagulant state [31]. Thereby, contributing to disorders such coronary artery disease (CAD), hypertension, cardiomyopathy and thromboembolic disorders ( Figure 1); the above findings have been correlated with histopathological case reports [32,33].…”

“…Structurally, several modalities of dysfunction that may predispose to sudden cardiac death have been proposed that includes cardiac hypertrophy, ventricular dilatation, myocardial fibrosis and cardiomyopathy. There have been several case reports of young athletes that have developed rapidly progressive (dilated) cardiomyopathy [31]. Ventricular arrhythmias are another possibility, where it has been suggested that anabolic steroids inhibit the reuptake of catecholamines, and with a combination of exercise, stimulating the nervous system that may increase the likelihood of fatal arrhythmias.…”