Performance enhancing drug abuse and cardiovascular risk in athletes: implications for the clinician

Abstract

The use of performance-enhancing and social drugs by athletes raises a number of ethical and health concerns. The World Anti-Doping Agency was constituted to address both of these issues as well as publishing a list of, and testing for, banned substances in athletes. Despite continuing methodological developments to detect drug use and associated punishments for positive dope tests, there are still many athletes who choose to use performance and image enhancing drugs. Of primary concern to this review are the health consequences of drug use by athletes. For such a large topic we must put in place delimitations. Specifically, we will address current knowledge, controversies and emerging evidence in relation to cardiovascular (CV) health of athletes taking drugs. Further, we delimit our discussion to the CV consequences of anabolic steroids and stimulant (including amphetamines and cocaine) use. These drugs are reported in the majority of adverse findings in athlete drug screenings and thus are more likely to be relevant to the healthcare professionals responsible for the wellbeing of athletes. In detailing CV health issues related to anabolic steroid and stimulant abuse by athletes we critique current research evidence, present exemplar case studies and suggest important avenues for on-going research. Specifically we prompt the need for awareness of clinical staff when assessing the potential CV consequences of drug use in athletes.

Performance-Enhancing Drugs

“…37 Users combine multiple AAS ("stacking"), increase then decrease doses ("pyramiding") during each cycle of use, and cycle on and off to let their hormonal systems recover 38 ; take human growth hormone (hGH) 37 ; and add drugs to counteract AAS side effects (eg, human chorionic gonadotropin, 37 tamoxifen, and isotretinoin, to limit testicular atrophy, gynecomastia, and acne, respectively). 27 Because of constant improvements in drug testing in recent decades, athlete AAS use has shifted from pharmaceutical xenobiotics to T, to prohormones, to designer steroids (developed only to elude anti-doping tests). 35,37 Meanwhile, AAS use has spread to the general population.…”

“…27,41 High-dose AAS can increase total cholesterol 42 ; they increase lowdensity lipoprotein cholesterol and markedly suppress high-density lipoprotein (HDL) cholesterol. 18,27 One author (G.A.G.) has seen an HDL level of less than 10 mg/dL in users of multiple AAS, especially nandrolone.…”

Public Health Measures to Combat the Menace of Drug Abuse

“…Substance abuse has produced a significant impact on health and social dimensions like poor academic performance [26]; increase in the incidence of school dropouts [6]; rise in cases of juvenile delinquency [27]; aggravated cases of familial disharmony [26]; enhanced cardiovascular risks [28]; psychological morbidities like depression and adjustment disorders Abstract Drug abuse is defined as self-administration of a drug for non-medical reasons, in such amount and periodicity which may impair the ability to function adequately and which may result in social, physical, or emotional harm. A wide range of biological, genetic, medical, social, and environmental factors have influenced people from the community for the drug abuse.…”

Dietary Supplements Use in Competitive and Non-Competitive Boxer: An Exploratory Study

“…Furthermore, all athletes, amateurs and professionals, could be in serious danger because their medical and technical staff, their friends and others could often suggest the consumption of the above-mentioned substances. Several reasons could explain the decision made by athletes to intake DS: to balance nutritional deficiencies, to reduce inflammation and/or to enhance performance [25][26][27].…”