Cardiovascular Effects of Anabolic Steroids

The provided documents are a collection of research papers and case studies that investigate the cardiovascular effects of anabolic steroid use in male bodybuilders. The studies examine the long-term consequences of anabolic steroid use on the heart, including left ventricular dysfunction, atrial electromechanical delay, and cardiogenic shock. The research also explores the association between anabolic steroid use and cardiovascular risk factors such as blood pressure and lipid profiles. The papers are sourced from reputable scientific journals and provide a comprehensive overview of the topic.

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Montisci M, El Mazloum R, Cecchetto G, Terranova C, Ferrara SD, Thiene G, Basso C.
Anabolic androgenic steroids abuse and cardiac death in athletes: morphological and
toxicological findings in four fatal cases. Forensic science international. 2012 Apr
10;217(1-3):e13-8.
The study has focused on the four cases of athletes that were healthy previously and
users of AAS. The first case has indicated that different pathological changes could occur due
to chronic intake of AAS. Such changes are non-reversible and dose dependent even after the
withdrawal of AAS and sudden death could occur after a long time of withdrawal of the drug
due to irreversible myocardial changes. The second case has identified the occurrence of
congestive heart failure due to dilated cardiomyopathy associated with interstitial fibrosis and
the correlations of extensive myocardiocytolysis with prolong exposure to AAS. The third
case has indicated that arrythmogenic substrate is related to event of malignant ventricular
arrhythmias that results in SCD in the athletes that are AAS users. The fourth case has
elaborated that cardio toxicity of cocaine is related to the hypersensitivity myocarditis (1).
Neto OB, da Mota GR, De Sordi CC, Resende EA, Resende LA, da Silva MA, Marocolo
M, Côrtes RS, de Oliveira LF, da Silva VJ. Long-term anabolic steroids in male
bodybuilders induce cardiovascular structural and autonomic abnormalities. Clinical
Autonomic Research. 2018 Apr 1;28(2):231-44.
The study has focused to explore the hypothesis that cardiac autonomic disorders are
correlated with the users of anabolic androgenic steroids or AAS. The result has indicated
that risk of high BP and cardiac sympathetic modulation is greater for the bodybuilders that
are associated with AAS than the AAS non-users as their sedentary control is lower. Such
sympathetic modulation leads to the structural alteration of heart thus, cardiovascular risk is
higher in case of AAS abusers.

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The graphical representation has shown the heart rate and mean BP of the participants.
Source: (2)
Hassan NA, Salem MF, Sayed MA. Doping and effects of anabolic androgenic steroids
on the heart: histological, ultrastructural, and echocardiographic assessment in strength
athletes. Human & experimental toxicology. 2009 May;28(5):273-83.
The study has shown that the bodybuilders that use steroids for improving
performance face enormous structural and functional changes. For example, small left
ventricular dimension associated with thick wall, diastolic dysfunction and high systolic
strain rate. Light microscopy has identified degenerated areas in cardiac muscle and loss of
vacuolation in such body builders. It has been established in the study that higher dose of
AAS caused chronic deleterious effects in Myocardium (3).
Ismail TF, Angell PJ, Jabbour A, Smith G, Wage R, Hewins B, Mistry N, Dahl AL,
Clark S, Cowley B, George K. Cardiac effects of anabolic steroid use amongst
recreational body builders-a CMR study. Journal of Cardiovascular Magnetic
Resonance. 2012 Dec;14(1):P186.

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The study has aimed to find out the cardiac effects of anabolic steroid use in
association with CMR. Result has elaborated that the steroid users contain left ventricular
hypertrophy with increased mass and wall thickness of left ventricular. Left ventricular
remodelling index is also higher for steroid users as compare to non-users. Excessive
thickness of left ventricular such as >15 leads to the diagnosis of hypertrophic
cardiomyopathy.
The table has shown the comparison between the structure of LV and RV of athletes that are
AAS users and non-users.
Source: (4)
Baggish AL, Weiner RB, Kanayama G, Hudson JI, Picard MH, HutterJr AM, Pope Jr
HG. Long-term anabolic-androgenic steroid use is associated with left ventricular
dysfunction. Circulation: Heart Failure. 2010 Jul;3(4):472-6.
The study has compared the cardiac parameter of weightlifters that were AAS users
with the AAS non-users. It has been found in the study that left ventricular ejection fraction is
lower in case of AAS users as compare to non-users. Out of 12 participants that are AAS
users have shown extremely low left ventricular ejection that is below the normal ejection
limit. Reduced diastolic function has been found with extremely low E velocity in the AAS

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users. Thus, it can be said that cardiac dysfunction due to prolong exposure to AAS could
lead to the risk of heart failure (5).
Gheshlaghi F, Piri-Ardakani MR, Masoumi GR, Behjati M, Paydar P. Cardiovascular
manifestations of anabolic steroids in association with demographic variables in body
building athletes. Journal of research in medical sciences: the official journal of Isfahan
University of Medical Sciences. 2015 Feb;20(2):165.
The study was designed to evaluate the effect of anabolic consumption on
cardiovascular outcomes in body builder athletes. The result has indicated decrease in the
low-density lipoprotein in the anabolic steroid consumers. This is due to high consumption of
lipid. Due to long duration of steroid abuse, a momentous increase in the systolic blood
pressure and diastolic blood pressure has been found in the steroid users. The study has
indicated that extreme use of anabolic steroid could lead to serious cardiovascular disorder.
The figure is showing the difference in the systolic blood pressure and diastolic blood
pressure in AAs users and non-users. From the figure it has cleared that both the SBP and
DBP is higher in case of AAS users.
Source: (6)
Achar S, Rostamian A, Narayan SM. Cardiac and metabolic effects of anabolic-
androgenic steroid abuse on lipids, blood pressure, left ventricular dimensions, and
rhythm. The American journal of cardiology. 2010 Sep 15;106(6):893-901.

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The study has focused on the effects of AAS abuse on cardiovascular system, thus
reviewed some studies retrieved from effective database. The result has indicated that
mortality is high in AAS abusers due to cardiovascular risk. AAS abuse leads to plasma
lipoprotein abnormality. Such abnormality in lipoprotein level could lead to the risk of
coronary artery disease. It has been found that AAS abuse could increase the LV hypertrophy
and fatal events such as sudden death (7).
Thiblin I, Garmo H, Garle M, Holmberg L, Byberg L, Michaëlsson K, Gedeborg R.
Anabolic steroids and cardiovascular risk: a national population-based cohort study.
Drug and alcohol dependence. 2015 Jul 1;152:87-92.
The study has aimed to establish that non-therapeutic use of AAS leads to adverse
effects. The study has indicated that risk of cardiovascular mortality and morbidity is two
times higher in the people that are AAS users as compare to the AAS non-users. Such abuse
of AAS leads to premature death as well. Standardized mortality ratio is also high for AAS
abusers. Such result has indicated the occurrence of adverse effect due to non-therapeutic use
of AAS (8).
Baggish AL, Weiner RB, Kanayama G, Hudson JI, Lu MT, Hoffmann U, Pope HG.
Cardiovascular Toxicity of Illicit Anabolic-Androgenic Steroid UseClinical Perspective.
Circulation. 2017 May 23;135(21):1991-2002.
The study has designed to establish the association of cardiovascular risk with illicit
use of AAS. Result of the study has indicated that lower LV systolic and diastolic function in
AAS users as compare to non-users. Furthermore, high coronary artery plaque volume has
been noticed in the Current AAS users. The study has elaborated that lifetime dose of AAS
leads to the increased burden of coronary atherosclerotic and for each 10 years plaque volume
increase the duration of AAS abuse.

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The table has shown the structural and functional changes in the AAS users as compared to
AAS non-users.
Source: (9)
Akçakoyun M, Alizade E, Gündoğdu R, Bulut M, Tabakcı MM, Açar G, Avcı A, Şimşek
Z, Fidan S, Demir S, Kargın R. Long-term anabolic androgenic steroid use is associated
with increased atrial electromechanical delay in male bodybuilders. BioMed research
international. 2014;2014.
The study has investigated the presence of atrial conduction abnormalities in athletes
that are AAS users.

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Source: (10)
The table has indicated that PA lateral and PA septum are higher in AAS users as
compare to AAS non-users. In AAS using body builders the interatrial and intra-atrial EMD
values are also high. Thus it can be said that AAS abuse and atrial fibrillation recurrence are
correlated.
Luijkx T, Velthuis BK, Backx FJ, Buckens CF, Prakken NH, Rienks R, Willem PT,
Cramer MJ. Anabolic androgenic steroid use is associated with ventricular dysfunction
on cardiac MRI in strength trained athletes. International journal of cardiology. 2013
Aug 10;167(3):664-8.
The aim of the study was to identify the effect of resistance training and relation of
AAS-use with cardiac function and dimensions. The result has indicated that volume and
mass of left ventricle and right ventricle is higher in the athletes that are AAS abusers, but
lower than the high dynamic-high statics athletes that use AAS. Lower ejection function of
LV and RV has been found in such athletes group. Due to the effect of AAS use a significant
change in the EDV, EDM, mitral valve E/A ration and systolic function has been indicated by
the study (11).
Lunghetti S, Zacà V, Maffei S, Carrera A, Gaddi R, Diciolla F, Maccherini M,
Chiavarelli M, Mondillo S, Favilli R. Cardiogenic shock complicating myocardial
infarction in a doped athlete. Acute cardiac care. 2009 Jan 1;11(4):250-1.

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It has been found in the study that Abuse of drugs such as erythropoietin and
nandrolone with intense isometric exercise leads to the state of pro-coagulant that increases
the risk of myocardial infarction and chronic coronary thrombosis. Such condition leads to
the development of life threatening complications such as cardiovascular risk like CAD.
However, support from the pharmacological and mechanical team and heart transplantation
due to availability of a donor could lead to positive outcomes (12).
Ahlgrim C, Guglin M. Anabolics and cardiomyopathy in a bodybuilder: case report and
literature review. Journal of cardiac failure. 2009 Aug 1;15(6):496-500.
The study has elaborated that prolong abuse of AAS causes adverse effects events, for
example, myocardial infarction, ventricular fibrillation, atrial fibrillation, cardiomyopathy
and even sudden death. It has been found that chronic resistance training such as
bodybuilding and weight lifting increases the volume, mass and thickness of the left
ventricle, thus leads to structural changes of LV. Such changes increase the risk of stroke to a
significant degree in the bodybuilders than other athletes (13).

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References:
1. Montisci M, El Mazloum R, Cecchetto G, Terranova C, Ferrara SD, Thiene G, Basso
C. Anabolic androgenic steroids abuse and cardiac death in athletes: morphological
and toxicological findings in four fatal cases. Forensic science international. 2012 Apr
10;217(1-3):e13-8.
2. Neto OB, da Mota GR, De Sordi CC, Resende EA, Resende LA, da Silva MA,
Marocolo M, Côrtes RS, de Oliveira LF, da Silva VJ. Long-term anabolic steroids in
male bodybuilders induce cardiovascular structural and autonomic abnormalities.
Clinical Autonomic Research. 2018 Apr 1;28(2):231-44.
3. Hassan NA, Salem MF, Sayed MA. Doping and effects of anabolic androgenic
steroids on the heart: histological, ultrastructural, and echocardiographic assessment
in strength athletes. Human & experimental toxicology. 2009 May;28(5):273-83.
4. Ismail TF, Angell PJ, Jabbour A, Smith G, Wage R, Hewins B, Mistry N, Dahl AL,
Clark S, Cowley B, George K. Cardiac effects of anabolic steroid use amongst
recreational body builders-a CMR study. Journal of Cardiovascular Magnetic
Resonance. 2012 Dec;14(1):P186.
5. Baggish AL, Weiner RB, Kanayama G, Hudson JI, Picard MH, HutterJr AM, Pope Jr
HG. Long-term anabolic-androgenic steroid use is associated with left ventricular
dysfunction. Circulation: Heart Failure. 2010 Jul;3(4):472-6.
6. Gheshlaghi F, Piri-Ardakani MR, Masoumi GR, Behjati M, Paydar P. Cardiovascular
manifestations of anabolic steroids in association with demographic variables in body
building athletes. Journal of research in medical sciences: the official journal of
Isfahan University of Medical Sciences. 2015 Feb;20(2):165.

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7. Achar S, Rostamian A, Narayan SM. Cardiac and metabolic effects of anabolic-
androgenic steroid abuse on lipids, blood pressure, left ventricular dimensions, and
rhythm. The American journal of cardiology. 2010 Sep 15;106(6):893-901.
8. Thiblin I, Garmo H, Garle M, Holmberg L, Byberg L, Michaëlsson K, Gedeborg R.
Anabolic steroids and cardiovascular risk: a national population-based cohort study.
Drug and alcohol dependence. 2015 Jul 1;152:87-92.
9. Baggish AL, Weiner RB, Kanayama G, Hudson JI, Lu MT, Hoffmann U, Pope HG.
Cardiovascular Toxicity of Illicit Anabolic-Androgenic Steroid UseClinical
Perspective. Circulation. 2017 May 23;135(21):1991-2002.
10. Akçakoyun M, Alizade E, Gündoğdu R, Bulut M, Tabakcı MM, Açar G, Avcı A,
Şimşek Z, Fidan S, Demir S, Kargın R. Long-term anabolic androgenic steroid use is
associated with increased atrial electromechanical delay in male bodybuilders.
BioMed research international. 2014;2014.
11. Luijkx T, Velthuis BK, Backx FJ, Buckens CF, Prakken NH, Rienks R, Willem PT,
Cramer MJ. Anabolic androgenic steroid use is associated with ventricular
dysfunction on cardiac MRI in strength trained athletes. International journal of
cardiology. 2013 Aug 10;167(3):664-8.
12. Lunghetti S, Zacà V, Maffei S, Carrera A, Gaddi R, Diciolla F, Maccherini M,
Chiavarelli M, Mondillo S, Favilli R. Cardiogenic shock complicating myocardial
infarction in a doped athlete. Acute cardiac care. 2009 Jan 1;11(4):250-1.
13. Ahlgrim C, Guglin M. Anabolics and cardiomyopathy in a bodybuilder: case report
and literature review. Journal of cardiac failure. 2009 Aug 1;15(6):496-500.