Impact of anabolic androgenic steroids (AAS) on cardiovascular system of athletes- a systematic review

This systematic review evaluates the adverse effect of AS use on cardiac health of new and young athletes. It identifies the cause behind cardiovascular effect associated with the use of AS among athletes, assesses and describes different types of cardiovascular abnormalities caused due to the use of AS drug and suggests ways to curb use of AS drugs among young athletes.

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Impact of anabolic androgenic steroids (AAS) on
cardiovascular system of athletes- a systematic review
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Introduction
Methodology
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B
Results
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Summary and conclusion
References
Anabolic androgenic steroids (AAS) are the synthetic derivative of the human
hormone testosterone that has androgenic as well as anabolic effects. The
term anabolic effect relates to the increase in skeletal mass while the term
androgenic effects refer to the masculinisation features. As a result of these
beneficial properties, a large pool of athletes is in favor of consuming such
steroids. The reasons for the same encompass desire to gain weight,
strength and endurance (Nakhaee, Pakravan and Nakhaee 2013).
Nevertheless, significant concerns have emerged in the past regarding the
use of the performance enhancing drugs on the long term. A number of
negative health impacts have come into the limelight that has drawn the
attention of public health authorities (Neto et al. 2018). As such, the use of
AAS is reported to have detrimental impact on the cardiovascular system of
athletes consuming the same for competitive and non-competitive purposes
(Baggish et al. 2017).
It is thought desirable that an accurate review of current evidence is carried
out for understanding the contribution of AAS in development of
cardiovascular abnormalities. Validation of the research findings is also
critical in this regard. Critical analysis of existing research evidence might
help to identify the extent to which the drug can impair health of athletes.
The main aim of the systematic review was to evaluate the adverse effect of
AS use on cardiac health of new and young athletes.
The main objectives of the systematic review were as follows:
To identify the cause behind cardiovascular effect associated with the use
of AS among athletes
To assess and describe different types of cardiovascular abnormalities
caused due to the use of AS drug
To suggest ways to curb use of AS drugs among young athletes
Research Method- Qualitative research methodology was considered rational
and appropriate for the present research since such a method would provide
deep insight of the relevant literature in alignment with the project aim.
Synchronization of data was possible with this form of methodology (Taylor,
Bogdan and DeVault 2015)
Search strategy- a systematic literature review was carried out for the
present research to understand the effect of AAS on cardiovascular system
of young and adult athletes. It is possible to summarize the key findings of
available research papers through such a review (Silverman 2016). The
present review was done based on a preset criteria used for searching
articles
Databases and keywords used- PubMed, Science Direct, CINAHL and
Proquest were the databases used that have access to reliable, peer-
reviewed, full text journal articles. The databases are updated and cover a
wide range of journals on different subjects (Flick 2015). The keywords used
for the present review were as follows- Anabolic steroids, anabolic
androgenic steroids, cardiac health, cardiovascular system, cardiovascular
health, negative, effect, impact, outcome, athlete, young, adult, sport, sports.
Inclusion criteria-
•Age range 13-17 year for young athlete
•More than 18 for adult athlete
•Primary study (without reviews)
•Articles that explore effects of AS on human body
•Articles published in peer-reviewed journals
•Language: English / country population
•Year of publication: 2000 to 2018
•Peer reviewed journal articles
•Case studies
•Research methods: Qualitative
Exclusion criteria-
•Editorials or reviews
•Animal research
•Published in foreign languages
•Older than 2000
•Unpublished manuscripts and abstracts
•Book chapters
•Dissertation
Data collection and analysis- systematic and logical search was done for
retrieving suitable sources from the databases and analyzed for inclusion in
the review. Thematic analysis was done for identifying patterns of information
generated from the studies (Taylor, Bogdan and DeVault 2015).
Risk of cardiovascular effects due to the
use of AAS-
Baggish et al. (2010) conducted a study for understanding the association
between long term anabolic-anabolic steroid use and left ventricular
dysfunction. Recruitment of 12 long term athlete AAS users and 7 non users
was done. A 2 dimensional, tissue-Doppler, and speckle-tracking
echocardiography was carried out for assessing the left-ventricular (LV)
ejection fraction, LV systolic strain, and conventional indices of diastolic
function. It was found that AAS users had significantly lower longitudinal
strain (p = 0.004), lower LV ejection fraction (p = 0.003 by Wilcoxon rank sum
test, two-tailed); and radial strain (p = 0.02).
Akcakoyn et al. (2014) carried out Electrochemical coupling interval and
tissue Doppler imaging (TDI) for investigating atrial conduction abnormalities
in athletes using AAS. Recruitment of 12 AAS users and 18 non users was
done. The cross-sectional study indicated that the risk of inter and intra Atrial
electromechanical delay (AEMD) is higher in AAS users.
Baggish et al., (2017), carried out a cross-sectional cohort study, with 140
male weightlifters, between the age 34 and 54 years for understanding
cardiovascular association of AAS. Users of AAS had reduced LV systolic
function (mean ± SD left ventricular ejection fraction = 52±11% versus
63±8%; P<0.001) and diastolic function (early relaxation velocity = 9.3±2.4
cm/second versus 11.1±2.0 cm/second; P<0.001).
Thiblin et al. (2015) investigated cardiovascular mortality and morbidity in
athletes with AAS use by recruiting 2013 men enrolled in a cohort between
the year 2002 and 2009. 409 individuals tested positive for AAS use had
double the risk of suffering cardiovascular rate of morbidity and mortality
(adjusted hazard ratio (aHR) 2.0; 95% confidence interval (CI) 1.2–3.3).
Ahlgrim and Guglin (2009) reported a case study on use of androgenic
anabolic steroid by a 41 year old national level bodybuilding athlete. The
main inference drawn from the case report was that anabolic steroids can be
noted as a lesser significant causes of cardiomyopathy in young and healthy
athletes.
Effects on cardiovascular system due to the
use of AAS-
Gheshlaghi et al. (2015) carried out a research focusing on the evaluation
of cardiovascular outcomes in relation to 267 body building athletes aged 20-
45 years. Measurement of Triglyceride (TG), High-density lipoprotein (HDL),
low-density lipoprotein (LDL), and hematocrit (Hct) levels was done.
Statistical difference was found to occur in terms of LDL and Hct levels (P =
0.01 and P = 0.041, respectively). Diastolic and systolic blood pressure had
also significantly increased.
Climstein et al. (2003) recruited 23 power and strength athletes presenting
a current and past history of AAS consumption along with 23 control
individuals. Resting and immediate post-exercise transthoracic left ventricular
wall cardiokymograms indicated alterations in the motion of left ventricular
wall in cardiac system.
A research was carried out by Grace et al. (2003) with 32 participants for
investigating the impact of administration of AAS. Systolic and Diastolic
Blood Pressure, RPP, Resting Heart Rate and Body Composition were under
scrutiny. Increase in arterial blood pressures and diastolic blood pressure
(p<0.05 and p<0.01) was noted.
Underlying cause of effects on
cardiovascular system due to the use of
AAS
In the study of Luijkx et al. (2012) elucidation of the impact of resistance
training and use of AAS on athlete’s cardiac function and dimensions was
done. 156 male participants were recruited of age between 18 and 40 years
who underwent cardiac magnetic resonance (CMR). It was indicated that
strength athletes using AAS have impaired ventricular function, different
biventricular systolic dysfunction and cardiac dimensions.
Urhausen, Albers and Kindermann (2003) investigated adverse
cardiovascular effects of AAS. Doppler echocardiography and cycle
ergometry were carried out. The main finding was that systolic blood
pressure was higher in those using AAS (p<0.05).
Hassan, Salem and Sayed (2009) studied functional and structural
alterations suffered in the heart as a result of AAS. 25 male adult athletes
were recruited and underwent Two-dimensional, M-mode, tissue Doppler
imaging (TDI) and strain rate imaging (SRI). Simultaneously, 30 adult albino
rats were considered for the study. Interrupted Z-bands, loss of striation,
dehiscent intercalated disc, disruption in the banding pattern of cardiac
muscle fiber were marked.
Ismail et al. (2012) investigated the effect of use of anabolic steroid on
cardiac system with the help of cardiovascular magnetic resonance (CMR).
The study with 23 recreational body builders showed that left ventricular
hypertrophy occurs in AAS users.
Neto et al. (2017) measured changes in cardiac dimensions, blood
pressure and sympathetic modulation in AAS users. Higher blood pressure,
cardiac autonomic alteration was distinct. Increased sympathetic modulation
had a distinct association with structural changes in the individual’s heart.
Lunghtetti et al. (2009) put forward a case study of an athlete suffering
cardiogenic shock and myocardial infarction due to AAS use. The individual
in the case study was a 50 year old Caucasian bodybuilder, and a user of
erythropoietin and nandolone steroids.
Montisci et al. (2011) studied one case of concentric cardiac hypertrophy
with focal fibrosis, two cases of dilated cardiomyopathy with patchy myocyte
death and one case of eosinophilic myocarditis.
The present systematic review was carried out for addressing the research
aims and objectives in a suitable manner. Primary research articles were
considered that threw light on the research topic. Case study evidences have
also been studied in the present review. As a result of increased use of AAS
in sports and reports of cardiovascular abnormalities, attention is
continuously given to comprehensively understand the exact association
between AAS and cardiovascular system. There lies consensus that
cardiovascular impact of AAS in athletes is mostly negative. In spite of
contradictions in literature, the general standpoint is that young and adult
athletes are at high risk of suffering poor cardiovascular outcomes. AAS are
used for both competitive as well as recreational purposes. The commonly
suffered routes of cardiovascular system alterations are endothelial and
diastolic functions. The most commonly suffered effects are thrombotic risks
and blood pressure changes. In conclusion, immense efforts are to be given
for further understanding the relation of AAS and cardiovascular system of
athletes on long term and short term period.
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