Cardiac Risk and Anabolic Agents

This report examines the cardiac risks associated with the use of anabolic agents by athletes, particularly in football. It analyzes the side effects of anabolic steroids, their impact on cardiovascular health, and the clinical implications of their use for performance enhancement. The report is based on a systematic review of relevant literature and utilizes PICO and PRISMA frameworks for data collection and analysis.

CARDIAC RISK ASSOCIATED WITH USE
OF ANABOLIC AGENTS IN SPORT

ABSTRACT
Anabolic agents are the substances that are considered as androgenic steroids to increase
metabolism, muscle mass and on the other hand, it helps in reducing fatigue. Some Steroids are
Tibolone, Zilpaterol, Zeranol and Clenbuterol. It is considered as performance-enhancing drug,
which has increased cardiovascular risks. However, to control the use of anabolic agents World
anti doping agency have banned the use of substances for athletes.
The research will be focused on analysing increasing cardiac risk for Athletes with the
help of various researches and data collection. The researcher has chosen this topic because it is
increasing ethical and health concern for sports. Steroids abuse can be hazardous because its side
effects can not be controlled
Further, use of steroids make athletes dependent on its use for enhancing performance.
The research will be conducted with the help of exploratory design where scholars will explore
every possible aspect of study to derive accurate results and findings on clinical and health
concerns with use of anabolic agents.

TABLE OF CONTENTS
ABSTRACT.....................................................................................................................................2
RESEARCH TITLE.........................................................................................................................1
CHAPTER 1: INTRODUCTION....................................................................................................1
Background of study...............................................................................................................1
Aim.........................................................................................................................................2
Objectives...............................................................................................................................2
Questions................................................................................................................................2
Rationale of study...................................................................................................................3
Structure of dissertation..........................................................................................................3
CHAPTER 2: METHODS...............................................................................................................4
Search methods for identifying and refining studies..............................................................4
Data Collection.......................................................................................................................6
Data Analysis..........................................................................................................................6
Ethical consideration..............................................................................................................7
CHAPTER 3: RESULTS.................................................................................................................8
CHAPTER 4: DISCUSSION...........................................................................................................5
CHAPTER 5: CONCLUSION........................................................................................................5
REFERENCES................................................................................................................................6

RESEARCH TITLE
“To ascertain the cardiac associated risks due to use of anabolic agents by athletes: A case study
on football sport”.
CHAPTER 1: INTRODUCTION
Background of study
Anabolic agents are chemical substances that are not androgenic steroids but affects
human body like increase in muscle mass, high metabolism, decrease in fatigue and change in
recovery time due to their fundamental interaction with androgenic receptors. These agents are
available in all forms like tablet, liquid and skin patch form (Maroon and et.al., 2015).
Anabolic agents have both long term and short-term side effects on body that may
include heart attack, jaundice, liver damage, failed kidney, high blood pressure, headaches,
dizziness etc. Psychological side effects are also caused by these chemical substances like mood
swings, paranoia, agitation, restlessness, insomnia and depression. Cardiac risk is that risk, which
is related to human heart like chances of getting stroke or heart attack. It involves diseases
related to heart and blood vessels (Solberg and et.al., 2016).
There are many risk factors, which are associated with these diseases; main indicator of
risk is people health history that may include age, family history, alcohol consumption, smoking,
blood pressure, poor diet, unhealthy life style, diabetes, less physical activity etc. Some risk
factors cannot be altered like family history but other factors like blood pressure, diabetes can be
changed by providing proper treatment to patients (Naqvi and Flaherty, 2016). These risks
should accessed and managed by doctors as well as patients.
Cardiac risk is common among people who are involved in excess alcohol consumption,
obesity, high cholesterol and low educational status, high consumption of steroids, poor diet, and
smoking and raised blood sugar (KNieschlag and Vorona, 2015). Most of these factors can be
altered with treatment. Age and poor diet are also part of cardiac risk factor as the most people
who suffer from heart stroke are above age of fifty-five. Diet that contains more carbohydrate
fats, low intake of vegetables and fruits, and more consumption of junk foods can be termed as
poor diet, which can also cause cardiac diseases to human in taking it. Athletes are involved in
consuming anabolic agents in order to achieve success at any cost (Campos and et.al., 2017).
Mainly footballers use these chemical substances in high doses to improve their
performance and competitiveness. Sometimes coaches of football team also force footballers to
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have anabolic in order to build reputation for their team. These drugs help in promoting
aggressiveness, lean muscle mass and change in body weight. Many risks are involved in
consumption of these chemical substances like nausea, vomiting, increased risk of ligament and
tender injury, headaches, aching joints, depression, high sugar level, sleep problem and severe
acnes (Bird and et.al., 2016).
Thus, it can be said that consumption of these drugs mainly involves cardiac risk like
heart stroke and attack. Footballers also face problem related heart like increased cholesterol and
high blood pressure. It increases blood triglyceride and lower blood level of high density. High
use of these drugs by footballers can result in temporary infertility or sterility, altered sex drive,
painful erection, increase level of oestrogen, abnormal sperm production, reduce level of
Testosterone, shrinkage of testicles (DeKosky, Jaffee and Bauer, 2018). Heart related diseases
can also lead to death of athletes and also affect functioning of heart that results in many
problems related to cardiac. Consumption of anabolic agents only harms body of footballers and
there are no benefits related to health in consuming them.
Aim
“To ascertain the cardiac associated risks due to use of anabolic agents by athletes: A case study
on football sport”.
Objectives
 To explore side effects and actions of Anabolic Steroids in sport
 To determine use of anabolic agents by athletes to enhance their performance
 To analyse relation between cardiovascular risk and Anabolic steroids
 To evaluate clinical implication of in taking Anabolic steroids by Athletes for enhancing
performance
Questions
 What are the side effects and actions of Anabolic Steroids in sport?
 Explain the use of anabolic agents by athletes to enhance their performance?
 Describe relation between cardiovascular risk and anabolic steroids?
 What are the clinical implications of taking anabolic steroids by athletes for enhancing
performance?
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Rationale of study
The study is conducted with motive of boosting knowledge over use of steroids by
athletes. In various studies and researches, it has been evaluated that anabolic agents are used in
sports for enhancing performance. Further, the study is for academic interest, which will help in
gaining critical understanding over different concepts such as cardiovascular risks associated
with consumption of steroids. Moreover, it will outline chemical reaction of steroids which are
used for boosting performance specifically for footballers. On the other hand, the research is
based on secondary study, which will be analysing in the form of systematic review.
Structure of dissertation
Chapter 1 Introduction: This chapter of study will help in developing understanding over
research title on the basis of which dissertation will be followed.. This is an introductory phase,
which helps in analysing the needs of conducting study with regard to problems statement.
Chapter 2 Methods: This chapter helps in analysing design and approach of research which
helps in logical and analysing research information. Methodological tools play a vital role in
deriving search strategies such as Pico, Prisma etc. Deriving proper search tools of systematic
review helps the scholar in making entire process systematic and smooth.
Chapter 3 Results: In this, scholar will outline findings from different secondary researches
such as PubMed and Medline. The results will be based on secondary database, which have been
collected by scholar for different types of study. It is effective because it helps in gaining in
depth understanding over research aim to identify cardiac risks associated with consumption of
anabolic agents by athletes.
Chapter 4 Discussion: This chapter of dissertation is based on framing assumptions on the basis
of results to answer research questions. Discussion helps in analysing root cause of the problems
and measure to overcome. Further, it will assist in determining strengths and weaknesses of the
study. It is the stage of research which aids in drawing final conclusion and recommendations to
research aim.
Chapter 5 Conclusion and recommendations: It is the summary of entire research, which
outlines brief discussion of overall methods and findings of dissertation. It is the time saving
approach which enable knowledge over entire investigated results and methods used. However,
recommendations in the dissertation are framed on the basis of results and findings which are for
academic learning and knowledge.
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CHAPTER 2: METHODS
Search methods for identifying and refining studies
Search methods are used by scholar to appraise and identify unpublished and published
views and studies of different authors which are related to research topic. It isway of
systematically developingown understanding and experiences which the individual have learnt
from key searches.
Electronic searches
Electronic searches play a vital role in outlining different types of studies for addressing
one problem statement. It is focus of scholar is on determining appropriate use of keywords and
searches are based on specific words which are base of research topics and problems statement.
In this study, the focus of researcher is on databases and resources like science direct, PubMed
and Medline etc. However, database in study comprises of online journals that will include
studies on use of anabolic agents by athletes and risk associated with consumptions of steroids in
global context. Further, for refining electronic research the focus of investigator is on screening
references to which helps in providing evidence to study. Searching for references helps in
enhancing reliability and validity of investigation.
Keywords
Initial researches of study will be based on keywords like cardiac risk, anabolic agents,
supplements, anabolic steroid abuse, stimulants, nutritional supplements, stamina, strength etc.
Choosing words is the key task of study where it is important for researcher to ensure that
chosen words are viable and related to study. Moreover, it is necessary for scholar to make
choice of appropriate words, which helps in extracting maximum information for addressing
research problem. The keywords of study will be based on research aim, objectives and
questions.
Pico
Pico is a literature research strategy, which derives specific search framework where P
stands for patient, population or problems as per research elements. I stand for intervention
which are the base of study for discussion and findings (Shea and et.al., 2017). C stands for
comparison which will helps the scholar in developing critical understanding over problem
statement. O recognised as outcomes, which denotes final conclusion and findings of study on
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the basis of which recommendations are based. It is considered as effective research tool for
secondary research because it helps in outlining valid arguments.
It comprises the basic elements that can be beneficial for the investigator to drive results
for research problems. Thus, this study on cardiac risk is associated with consumption of
anabolic agents by football athletes, the research will make use of PICO (Ort and et.al., 2014).
Further, with the help of this tool, researcher is able to outline systematic review with help of
comparison from different publishers (Alfirevic and et.al., 2016).
Prisma
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Illustration 1: Prisma flow diagram

It is an evidence-based minimum set of items for reporting in systematic reviews and
meta-analyses. It is used by researcher for evaluating findings of different publishers, which are
being considered for results and discussion (Shamseer and et.al., 2015). It is particularly
effective for research based on PICO, which derives intervention of study.
In this research method, the scholar first seeks for searched data base and duplicity of
information in order to remove similar researched information and sources (Moher and et.al.,
2015). Further, methods help in evaluating eligibility for full articles in order to analyse its
benefit and limitations as per stated problems. Last step of flow diagram is synthesizing research
outcomes in order to draw final results and findings. Thus, it can be said that it is the most
effective approach that helps scholar in refining searched information and further eliminating
waste data (Barker and Pistrang, 2015). It is source of framing effective and reliable discussion
on the basis of electronic searches.
Data Collection
Collecting data is a crucial part of study, which is based on research of scholar. However,
it is necessary for the scholar to use appropriate keywords and search engine for extracting data.
There are various data collection methods that are primary and secondary, where primary data is
based on current findings and facts which help in final decision-making.
On the other hand, there is secondary data collection process, which is based on past
findings and facts collected and reviewed by numerous authors. Thus, the present study is based
on secondary source, which will be collected with the help of different research techniques as
search engines, Pico etc. The study is in form of systemic review where the focus of scholar is on
outlining information from different studies on one specific topic for developing logical and
analytical arguments.
Data Analysis
Analysing data is a crucial concern as it helps in drawing findings of research. However,
the study is based on key searches and reviews by different authors. Information transmission,
decision making in study helps in developing critical understanding over gathered information
from various sources. Managing data is a crucial concern, for which there are two research tools
that is Meta analysis, qualitative and quantitative. Quantitative tools are based on numerically
analysing results with the help of statistical tool that is Z test, correlation, T test etc.
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Further, there is qualitative analysis, which is analysed with the help of thematic analysis
and in theoretical form. Hence, the study is based on qualitative analysis where the results will be
analysed in form of different in results and discussion (Review articles, systematic reviews and
meta-analyses: which can be trusted? 2009).
Ethical consideration
Adhering to ethics play a vital role in managing effectiveness of data and therefore, it is
the foremost responsibility of researcher to ensure confidentiality of information shared by
different publishers. Further, the scholar aim is to make use of information for effective purpose
and not for offensive goal like harming anyone beliefs, values, attitude etc. Thus, to maintain
ethicality of data collection and analysis, the researcher will reference entire study and will in-
text arguments. This will help the researcher in maintaining reliability and validity of results and
discussions.
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CHAPTER 3: RESULTS
Theme 1: Use of anabolic Steroids
As per theme, it has been analyzed that anabolic agents are used by people for enhancing
physical performance, which were first experimented on soldiers in Germany by Nazi at the time
of Second World War. Further, it has been identified that athletes must recognize people for
consumption of anabolic agents in various countries across the globe.
However, in 1972 Olympics , 68 % of middle runners accepted the consumption of
steroids before performance to reboost their energy and strength (Smith and et.al., 2018). The
supplements are Anabolic-Androgenic steroids (AASs) that are artificially derived from male
hormone that is testosterone, which helps in maintaining effective growth muscle and is used for
developing male characterics.
Consumption of supplements to boost performance is considered as unethical and illegal
because Inversion of control was developed to detect the use of drug. Sports committee was
focused on banning use of steroids because apart from increasing strength, it is related to
cardiovascular risk (Anabolic Steroids, 2014). Further, it has been identified that intake of
steroids is addictive and has increased dependency of athletes for improving performance.
Apparently, it has been analyzed that steroids are used to treat medical conditions but are
being illegally used in sports to develop strength during performance. It is used by players to
endure strength, boost muscle mass and to reduce recovery time during practices (Angell and
et.al., 2018). Thus, it can be said that long term use of steroids as supplement leads to various
health corners like aggression, undesirable changes in body etc.
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Theme 2: Risks due to the use of anabolic agents by athletes
As per theme 2, it has been analyzed that long term use of Anabolic-Androgenic steroids
leads to side effects, which are related to cardiovascular risk such as heart stroke, acute chest
pain, etc. Further, it impacts liver, prostate and kidney of human body that could be life
threatening. In accordance with long term use of agents, it has been derived that left ventricle of
heart is responsible for pumping blood which becomes weak with continuous intake of steroids.
Apart from this, cardiac risk has been identified that consumption of steroids leads to
advise conditions such as testicular atrophy, gynaecomastia, psychological disorders,
hypogonadism etc. Intake of drugs leads to failure of contractile that leads to structural change
within ventricle and causes risk of blockage in flow of blood (Kanayama and Pope 2018). From
the drug screening of various athletes, it has been identified that intake of anabolic agents help in
boosting performance for specific period but makes body internally weak with continuous
consumption; it leads to weakening of muscle that denotes dependency of athletes on substance
use.
However, from various articles and studies, it has been discussed that consumption of
anabolic agents need to ban as it impacts functioning of human body where user experiences
tendon injuries, sensitive ligaments, vomiting, aching of joints, muscle cramps, sleeping
disorder, acne and diarrhea.
Moreover, it comprises of risk of liver disorder like cysts and tumors, heart problems like
stroke, attack (Zarghami and Nazari, 2018). On the other hand, it comprises changes in mood,
suicidal tendencies, hair loss, oily skin and patches. Thus, from the discussion, it can be said that
consumption of anabolic agents lead to overall body disorders that are treatable but incurable.
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Theme 3: Consumption of anabolic agents by athletes to enhance their performance
Herein, from theme 3, it has been identified that consumption of steroids by athletes to
enhance performance is related to various health and ethical concerns. In addition, it has been
analyzed that consumption of drugs is especially increasing among footballers as the game
requires huge strength to perform consistently on floor. From the study, it has been derived that
World Anti Doping Agency has banned the use of drug, but still there are players who dope
before game regardless of doping test which is performed before game.
Intake of steroids by athletes is completely banned and therefore, it is illegally sold in
black market. From the study, it has been identified that for footballers steroids have become a
necessity that impacts their body functioning (Niedfeldt, 2018). However, use of substance assist
the individual in boosting performance in group for specific time but on the other hand, it laid
long lasting impact on physical and emotion status of person. The athletes consuming steroids
faces issues like baldness, mood disorders, arrogance etc.
Angel and et.al., 2012, article has outlined example of 25 year old body builders who was
dependent on use of anabolic agents. According to history, it has been evaluated that, the
individual self complained for different cardiac problems for which further diagnosis has been
done. The individual was 1.93 m and 127 kg with LV mass of 218 g on MRI of cardiac.
In accordance with diagnosis, it has been determined that his left ventricle was normal
but right ventricle got reduced. Further, his diastolic function measured with ultra sound was
moderately depressed. Thus, it can be said that according to person who do not intake steroids
and the person who are dependent on use of anabolic agents, have body functioning which is
reflected in individuals natural body changes such as, physical appearance, hair, increased
heartbeat and mood disorders.
Theme 4: Relation between Cardiovascular risk and Anabolic steroids
As per theme 4, it has been derived that cardiovascular risk are directly associated with
consumption of anabolic agents, which is the most common among atheletes. However, from
different studies, it has been analyzed that consumption of drugs shrinken heart muscle that
impacts pumping and flow of blood in body (Althobiti and et.al., 2018). The shrink in heart
muscles increases the chances of blockage and strokes which is life threatening and uncertain.
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Steroids increase retention of salt and water, which expands blood volume. In accordance to this,
it can be said that various cardio vascular concerns are irreversible and become hazardous.
Apparently, it has been discovered that consumption of AS is most common among
athletes, as the individuals use it for enhancing performance. At the time of doping, individuals
did not realize increased addiction and dependency on drug but increasing health concern
determines abuse of substance (Anabolic Steroids and Sports: Winning at any Cost, 2018).
Further, cardiovascular diseases are more likely to be dependent upon increased activity of
shared physiological pathways. Nevertheless, it has been analyzed that dope testing among
athletes are being under estimated because of their increased dependency on substance use.
As per the study, it can be outlined that cardiovascular risks are directly related to
consumption of anabolic agents because its consumption is misused by athletes for boosting
performance (Andrews and et.al., 2018). It is specifically concerned to hear diseases because
doping increases blood triglyceride and level of cholesterol, which leads to increase in low
density Lipproteins and decline in HDL that is High density Lipproteins.
Theme 5: Clinical implication of in taking Anabolic steroids by Athletes for enhancing
performance.
According to theme 5, it has been identified that long term use of Anabolic-Androgenic
steroids cause cardiovascular toxicity and also lead to dependency of athletes on substance.
Addiction is the major cause that represents misuse of substance among society. However, high
concentrated AAS has increased risk of prostate cancer.
Moreover, from clinical implication of taking Anabolic steroids, it has been determined
that prolonged doping leads to psychiatric effects which includes dependence syndromes, mood
syndrome and progression to other forms of substance abuse (Salerno and et.al., 2018). In
accordance with clinical implications, it can be said that dosage of anabolic steroids work on lean
body mass. The dosage is based on D R curve and its dose effects when it exceeds 5000 mg per
week.
Thus, from the dosage and clinical study, it can be said that anabolic agents is used as
medication for improving mass of muscle with lean body. However, it is essential for users to
make its use as per prescription to avoid its side effects and dependency.
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Theme 6: Doping in sports and its spread to at-risk populations
According to theme 6, it has been derived that doping has become a common concern in
sports activities as it is used by athletes to enhance their performance. As per international sports
federation, creating awareness about drug abuse has become important in order to ban its use.
In accordance with this, committee has planned to organize educational programs,
medical camps, testing and supportive medical programs (Kanayama, Hudson and Pope, 2009).
It is a health as well as ethical concern because it is impacting mentality of young
upcoming athletes and also has increased dependency of sports people. As per drug misuse and
risks to population, the article has outlined about various other ways to enhance performance
such as training, hard work, modification in diets etc.
It is important for athletes to consider use of ethical substance in order to manage risk of
population. Sport is an activity that is directly related to society across the globe (Doping in
sports and its spread to at-risk populations: an international review, 2007). Majority of
population follows trends used by athletes. Therefore, it is necessary for an individual to promote
use of effective products and dietary routine in society instead of substance misuse that can lead
to various health risks.
Thus, from the discussion, it can be said that consumption of anabolic agents by athletes
is risky, because public follow up the trends of stars. As per the analysis, it has been determined
that consumption has increased frequency of mental illness in anabolic steroid abusers including
paranoid schizophrenia, mania and depression.
Theme 7: Pattern of administering use of anabolic steriods
According to theme 7, it has been identified that consumption of Anabolic steroids
depends from person to person. There are individuals who consume steroids as per prescription
for medical purposes.
On the other hand, there are individuals who abuses substance by doping and use it as
performance enhancer (Kicman, 2008). Apparently, there are three ways that helps in
administering use of Anabolic-Androgenic steroids that is cycling, which derives equivalent
period of in taking substance. The cycles of taking drug are 6 to 8 weeks, and its administration
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is done in cylclic pattern is administered in short intervals which help in analyzing appropriate
use and effect of substance on body.
On the other hand, there is pyramid administration which derives variation of cyclic
intervals to control substance use as per prescription. However, pyramid administration helps in
deriving short term side effects of steroids such as mood disorder, vomiting, nausea, arrogance,
aggression etc.
Theme 8: Use of Anabolic-Androgenic Steroids by footballers
According to theme 8, steroids are drugs used by athletes to improve their performance.
They help in growth of muscles and body. It acts like nutrients to their body. The main reason of
using steroids by footballers is that they require extra energy in playing football. Also, it has
been identified that energy gets reduced while playing matches so they must take some energy
drinks to maintain it. Besides this, steroids helps in improving their performance (Wood and
et.al., 2010).
Moreover, age is also another factor to use steroids by footballers. Another reason of
using steroids changes with climate. There are situtaion where players have to travel to different
places under different wheather conditions which is naother reason of incraesing use of steroids.
Thus, they require some extra energy to play. So they use steroids.
Further, increasing injuries occur while playing is another reason behind consumption of
anabolic agents as it helps in managing fast recovery.Steroids helps in preventing injures. Also, it
helps in fast growth of muscles. Moreover, it helps in increasing their diet and stamina. But on
the other hand, taking steroids may have adverse effect on their health for long time. It may lead
to some deficiencies. Sometimes, steroids can affect health as it may not be suitable for every
body type.It may result in muscle pain or reducing their performance level.
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CHAPTER 4: DISCUSSION
CHAPTER 5: CONCLUSION
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