News & EventsLong-term anabolic steroid use may weaken the heart more than previously thought and test prop nandrolone phenylpropionate increase the risk of heart failure, according to research reported in Circulation: Heart Failure anabolic steroid heart disease, ueart American Heart Association journal. Anabolic-androgenic steroids mimic sterpid naturally occurring testosterone, a muscle-building hormone that promotes male sexual characteristics. In the small study, investigators found that the left ventricle, the heart's main pumping chamber, was significantly weaker during contraction systolic function in participants who had taken steroids compared to a group of similar non-steroid users. A healthy left ventricle pumps out 55 percent to 70 percent of wteroid blood that fills the heart a measurement known as ejection fraction. Eighty-three percent of steroid users in the person study had a low pumping capacity ejection fraction less than 55 anabolic steroid heart disease that previous studies have linked to increased risk of heart failure and sudden cardiac death.
Anabolic Steroids Increase Risk for Heart Disease in Young and Middle-Aged Men
The use of anabolic-androgenic steroids AAS among athletes is not new, nor is concern about their potential cardiac effects, but it has been difficult to definitively document deleterious cardiovascular effects from these drugs.
There are case reports of unexpected myocardial infarctions 1 and even sudden cardiac death 2 in AAS users, but such reports are relatively rare given the reported widespread use of AAS. Moreover, their effects on cardiovascular risk factors are confusing. Oral synthetic steroids, such as stanozolol, reduce high-density lipoprotein and increase low-density lipoprotein cholesterol more than parenterally administered testosterone at similar androgenic doses, 3 suggesting that oral AAS are more atherogenic, but both stanozolol 4 and testosterone 5 decrease lipoprotein a , an important atherosclerotic risk factor.
There is also concern that AAS increase blood pressure, but even the literature on this topic is equivocal, 6 and some of the purported increase in blood pressure with AAS may be due to the use of undersized sphygmomanometer cuffs in subjects with increased arm circumference.
AAS have more consistently been shown to impair left ventricular LV diastolic function, 8 — 10 and these clinical studies are supported by pathological evidence of increased myocardial collagen content after exposure to AAS.
In contrast to these subtle effects of AAS on systolic function, Baggish et al 13 in this issue of Circulation: Heart Failure present evidence that chronic, high-dose AAS use produces a dramatic impairment of LV systolic function. These authors recruited 19 male weightlifters, including 12 with prolonged AAS use.
Recruitment was designed to minimize selection biases. The AAS users were remarkable for both their steroid dose and duration of use. For comparison, subjects in prior studies generally reported weekly AAS doses equivalent to to mg of testosterone, 3 , 7 whereas subjects in the present study reported a median weekly dose equivalent to mg of testosterone.
The present subjects also reported a median of almost 9 years of steroid use. These investigators confirmed the decreased early, and increased late, diastolic filling in the AAS users noted previously.
LV hypertrophy did not differ between AAS users and control subjects. Both radial and longitudinal strain, measures of myocardial systolic function, were decreased in the AAS users, but more impressive was the decrease in LV ejection fraction LVEF.
There was no statistical association between dose and duration of AAS use and LVEF, but the small sample size precludes eliminating this possibility. We suspect that both the dose and duration of use are part of the explanation for the novelty of these findings, but this hypothesis awaits confirmation.
It is difficult to separate duration of use from age, however, and the age median, 40 years of AAS users in the present study is older than in most prior reports. There are limitations to the present report. The number of participants is small. The authors correctly note that this is more likely to cause a type II error, or false-negative finding, but this assumes that the effect is entirely due to the exposure being studied.
Other causes of reduced LV systolic function, such as other drug use, could be clustered in the AAS subjects, confounding the results. Supraphysiologic levels of GH have been associated with diastolic 14 and systolic dysfunction, although the later requires chronic exposure.
Consequently, GH use may be a significant confounder. The authors tried to reduce selection bias, but the possibility remains that participants enrolled for a medical evaluation because of mild symptoms. Blood pressure, ECGs, and an assessment of overall atherosclerotic risk were not provided, so occult atherosclerotic disease cannot be excluded as a mechanism for the effect; however, none of the participants reported hypertension, atherosclerotic disease, or heart failure.
These results, if confirmed, require that AAS use be considered in the differential diagnosis of LV systolic dysfunction and suggest that the prevalence of this problem may increase as long-term AAS users reach middle age.
These results also raise the haunting possibility that long-term AAS use can produce a clinically symptomatic cardiomyopathy. This report might spur the detection of such cases and the confirmation of this possibility.
The opinions expressed in this article are not necessarily those of the editors or of the American Heart Association. We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address. Skip to main content. Parker , Paul D. Jump to Article Footnotes References. Editorials anabolic steroids systolic dysfunction The use of anabolic-androgenic steroids AAS among athletes is not new, nor is concern about their potential cardiac effects, but it has been difficult to definitively document deleterious cardiovascular effects from these drugs.
Article see p AAS have more consistently been shown to impair left ventricular LV diastolic function, 8 — 10 and these clinical studies are supported by pathological evidence of increased myocardial collagen content after exposure to AAS. Footnotes The opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.
Acute myocardial infarction in a year-old world class weight lifter using anabolic steroids. Sudden cardiac death in a year-old bodybuilder using anabolic steroids. Contrasting effects of testosterone and stanozolol on serum lipoprotein levels. Reduction of lecithin-cholesterol acyltransferase, apolipoprotein D and the Lp a lipoprotein with the anabolic steroid stanozolol.
Testosterone decreases lipoprotein a in men. Blood pressure and rate pressure product response in males using high-dose anabolic androgenic steroids AAS.
J Sci Med Sport. The blood pressure response to exercise in anabolic steroid users. Med Sci Sports Exerc. Left ventricular early myocardial dysfunction after chronic misuse of anabolic androgenic steroids: Br J Sports Med.
Doping and effects of anabolic androgenic steroids on the heart: Cardiovascular effects of androgenic anabolic steroids in male bodybuilders determined by tissue Doppler imaging.
Heart lesions associated with anabolic steroid abuse: Left ventricular function is not impaired in weight-lifters who use anabolic steroids. J Am Coll Cardiol. Long term anabolic-androgenic steroid use is associated with left ventricular dysfunction. Growth hormone, acromegaly, and heart failure: Previous Article Next Article. Heart Failure July , Volume 3 , Issue 4. Parker and Paul D. Share this Article Email. Thank you for your interest in spreading the word on Circulation: You are going to email the following Anabolic-Androgenic Steroids.
Message Subject Your Name has sent you a message from Circulation: Message Body Your Name thought you would like to see the Circulation: Heart Failure web site. Share on Social Media.