Cardiotoxicity of Illicit Anabolic Steroid Use

Study Questions:

What are the long-term cardiovascular effects of illicit anabolic-androgenic steroid (AAS) use?

Methods:

Using a cross-sectional cohort design, 140 experienced male weightlifters 34-54 years of age were recruited, including 86 men reporting ≥2 years of cumulative lifetime AAS use and 54 nonusing men. Using transthoracic echocardiography and coronary computed tomography angiography, three primary outcome measures were assessed: left ventricular (LV) systolic function (LV ejection fraction [EF]), 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 ± standard deviation [SD] LVEF 52 ± 11% vs. 63 ± 8%, p < 0.001) and diastolic function (early relaxation velocity 9.3 ± 2.4 cm/s vs. 11.1 ± 2.0 cm/s, p < 0.001). Users currently taking AAS at the time of evaluation (n = 58) showed significantly reduced LV systolic (LVEF 49 ± 10% vs. 58 ± 10%, p < 0.001) and diastolic function (early relaxation velocity 8.9 ± 2.4 cm/s vs. 10.1 ± 2.4 cm/s, p = 0.035) compared with prior 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 vs. 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. The authors concluded that these forms of AAS-associated adverse cardiovascular phenotypes may represent a previously under-recognized public health problem.

Perspective:

Millions of individuals have used illicit AAS, but because their use first appeared in the general population only in the 1980s, most people who use or used the drugs are still young or middle-aged. These data suggest that long-term illicit anabolic steroid use is associated with LV systolic and diastolic dysfunction, and (associated with lifetime duration of exposure) coronary atherosclerosis. Because a large majority of contemporary illicit anabolic steroid users are recreational weightlifters rather than competitive athletes, the possibility of illicit anabolic steroid use should be considered in young or middle-aged men with evidence of otherwise unexplained LV dysfunction or coronary artery disease.

Clinical Topics: Cardio-Oncology, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Acute Heart Failure, Interventions and Coronary Artery Disease, Interventions and Imaging, Angiography, Computed Tomography, Echocardiography/Ultrasound, Nuclear Imaging

Keywords: Atherosclerosis, Cardiomyopathies, Cardiotoxicity, Coronary Artery Disease, Coronary Angiography, Diastole, Echocardiography, Heart Failure, Outcome Assessment (Health Care), Phenotype, Plaque, Atherosclerotic, Primary Prevention, Systole, Testosterone Congeners, Tomography, X-Ray Computed, Ventricular Function, Left


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