This post is authored by Michael S. Emery, MD, FACC, member of the ACC’s Sports and Exercise Section.

Recently a diverse group of cardiologists, sports medicine physicians, pediatricians, athletic trainers, patient families, representatives of college and professional sports, researchers, military physicians, and others met for the first Sports Cardiology Think Tank, followed by the first Sports Cardiology Summit.

More than 200 participants joined the summit, a lively two-day educational forum that included interactive discussions of case studies; a debate about adding ECGs to screening; presentations about differences in athletes based on sports played, gender, age; and a presentation by the family of a 9-year-old boy who died from anomalous origination of a coronary artery from the opposite sinus after two years of failure to get an accurate diagnosis. It was truly a dynamic meeting, which I was honored to be a part of.

During the summit, I spoke on performance enhancing drugs (PEDs) and their cardiovascular effects and risks. This is a hot topic since there continues to be a lot of buzz in the media about PEDs, especially in baseball and cycling (particularly with the recent news that Lance Armstrong has been stripped of his seven Tour de France titles and has been banned for life).

It is highly probable that this topic is even more prevalent than reported. However, beyond the legal implications and questions of ethics, the question becomes what are cardiovascular effects and risks of using PEDs?

Unfortunately, not a lot is known as studies are typically small, observational studies, or case reports. The most common PEDs are anabolic-androgenic steroids (AAS), often taking multiple as a “stack” at supraphysiological doses for prolonged periods in “cycles.” Others include human growth hormone, erythropoietin (EPO) and blood doping, which all have even less data available. Cardiovascular effects can include systolic dysfunction, diastolic dysfunction, accelerated atherosclerosis, myocardial infarction, arrhythmias, hypertension and dyslipidemia (particularly low HDL).

Over the counter supplements are another diverse group of “performance enhancers” legal in the U.S. but are not controlled by the U.S. Food and Drug Administration (FDA) and may contain a number of different substances with varying names.  Knowing what an athlete may be ingesting with these and what role they may play with regards to any cardiovascular side effects is often difficult.

We as cardiologists also need to be mindful of the use of prescription medications for athletes as some are prohibited from use in competitive sports.

The bottom line is more data is needed but since studies are difficult due to the “black market/underground nature,” it is almost impossible to have a controlled study. This is indeed a conundrum that my colleagues and I are faced with, which we are striving to overcome.

For more information about the ACC’s Sports and Exercise Cardiology Council and Section, click here.  

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