- Demonstrated that use of anabolic-androgenic steroids (AAS) is associated with compromised heart pumping and atherosclerotic plaque.
- Suggests that clinicians should inquire about AAS use when young or middle-aged men present with left ventricular dysfunction or coronary artery disease.
An estimated 3 million to 4 million Americans have used anabolic-androgenic steroids (testosterone or synthetic derivatives of testosterone) to gain muscle mass for sports or to enhance their appearance. A large new study demonstrates that such use can narrow the coronary arteries and impair left ventricular (LV) function. Together, these effects can reduce the supply of oxygenated blood both to the heart and from the heart to the arteries.
Dr. Aaron Baggish and colleagues at Massachusetts General Hospital in Boston and McLean Hospital in Belmont, Massachusetts, assessed the heart and coronary arteries in 140 male weightlifters ages 34 to 54. All the men could bench-press 275 pounds at some point in their lives; 58 were currently using AAS; 28 had previously used AAS for at least 2 years; and 54 had never used AAS. Compared with the nonusers, the AAS users had higher mean blood pressure and prevalence of elevated low-density lipoprotein (“bad”) cholesterol, which is a risk factor for atherosclerosis.
Echocardiography revealed that 71 percent of current AAS users had a lower-than-normal LV ejection fraction, a measure of how much oxygenated blood the heart delivers to the arteries with each contraction (see Figure 1). Half of current AAS users exhibited slower-than-normal LV expansion, indicating that reduced amounts of oxygenated blood flowed in to refill the LV during the relaxation phase of the heartbeat. These impairments likely were related to thickening of the LV muscle wall in the AAS users. Former AAS users had a larger LV ejection fraction than current users, suggesting that their LV had recovered some pumping strength.
In this boxplot, black dots represent individual weightlifters’ LVEF. All LVEF values below the horizontal red line are below the normal range, suggesting compromised heart pumping capacity. The horizontal line inside the box for each group represents the median LVEF in the group. The top and bottom lines of the boxes represent the 75th and 25th percentile LVEF in each group. Dots outside of the horizontal lines above and below each box represent weightlifters with extremely high or low LVEF, based on the overall range of LVEF in that group.
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AAS users also had significantly more atherosclerotic plaque in their coronary arteries than did nonusers (see Figure 2). This effect was more pronounced the longer they had taken AAS and did not seem to be reversible after discontinuing AAS use. Coronary atherosclerotic plaque obstructs blood flow to the heart muscle, increasing the risk of ischemia, heart attack, and heart failure. Notably, three AAS users, but none of the nonusers, had suffered heart attacks due to coronary artery disease at relatively young ages (38, 43, and 46 years). Another user experienced heart failure with underlying coronary artery disease at age 42.
The researchers found no differences in cardiovascular structure and function between AAS nonuser weightlifters and nonusers who were not weightlifters. This observation confirmed that none of the observed changes could be attributed to weightlifting itself.
Dr. Harrison G. Pope, one of the study’s primary researchers, concludes, “This study provides strong evidence that anabolic steroids pose serious and sometimes even fatal dangers to the muscle and the blood vessels of the heart. Given that some 3 million Americans have tried these drugs, this represents a significant public health problem.”
Dr. Jag H. Khalsa, Chief of NIDA’s Medical Consequences of Drug Abuse and Co-Occurring Infections Branch, agrees, pointing out that the findings contradict the general perception that AAS use is safe. “It is of paramount importance that clinicians are made aware of this highly significant finding so that they can advise their patients about the dangers of anabolic steroid use,” he emphasizes.
This study was supported by NIH grant DA029141.
Baggish A.L., Weiner, R.B., Kanayama, et al. Cardiovascular toxicity of illicit anabolic-androgenic steroid use. Circulation 135(21):1991-2002, 2017.
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NIDA. (2017, November 30). Anabolic-Androgenic Steroids May Damage the Heart and Arteries. Retrieved from https://www.drugabuse.gov/news-events/nida-notes/2017/11/anabolic-androgenic-steroids-may-damage-heart-arteries