Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

CV Toxicity of Illicit Anabolic-Androgenic Steroid Use

Circulation; ePub 2017 May 22; Baggish, et al

The long-term use of anabolic-androgenic steroids (AAS) is associated with myocardial and accelerated coronary atherosclerosis, according to a recent study that examined the long-term effects of these drugs on experienced male weightlifters. The cross-sectional study included 140 participants aged 34 to 54 years, comprising 86 men reporting ≥2 years of cumulative lifetime AAS use and 54 nonusing men. 3 primary outcome measures were assessed: left ventricular (LV) systolic function, LV diastolic function, and coronary atherosclerosis. Researchers found:

  • Compared with nonusers, AAS users demonstrated relatively reduced LV systolic function and diastolic function.
  • Compared with users currently off drug (n=28), users currently taking AAS at the time of evaluation (n=58) showed significantly reduced LV systolic and diastolic function.
  • AAS users demonstrated higher coronary artery plaque volume vs nonusers.
  • Lifetime AAS dose was strongly associated with coronary atherosclerotic burden in rank of plaque volume for each 10-year increase in cumulative duration of AAS use.

Citation:

Baggish AL, Weiner RB, Kanayama G, et al. Cardiovascular toxicity of illicit anabolic-androgenic steroid use. [Published online ahead of print May 22, 2017]. Circulation. doi:10.1161/CIRCULATIONAHA.116.026945.

Commentary:

Approximately 3 to 4 million individuals in the US, primarily males interested in gaining muscle mass, have used supraphysiologic doses of anabolic- androgenic steroids (AAS), including testosterone and related compounds. For years, there has been a concern about the relation between AAS use and CV disease. This concern is based primarily on case reports of MI and sudden death in young weight lifters in their 20s to 30s, as well as studies showing increased CV endpoints in older individuals.1,2 Other studies have not shown an increase in CV events with testosterone replacement.3 This carefully conducted observations trial strongly supports these concerns. As the best study to date on the topic, it shows that AAS use is associated with decreased myocardial contractile ability as reflected in decreased ejection fractions, as well as an increase in coronary atherosclerosis. —Neil Skolnik, MD

  1. Hartgens F, Kuipers H. Effects of androgenic-anabolic steroids in athletes. Sports Med. 2004;34:513–554. doi:10.2165/00007256-200434080-00003.
  2. Basaria S, Coviello AD, Travison TG, et al. Adverse events associated with testosterone administration. N Engl J Med. 2010;363:109–122. doi:10.1056/NEJMoa1000485.
  3. Calof OM, Singh AB, Lee ML, et al. Adverse events associated with testosterone replacement in middle-aged and older men: A meta-analysis of randomized, placebo-controlled trials. J Gerontol. 2005;60A:1451–1457.

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