Cardiovascular phenotype of long-term anabolic-androgenic steroid abusers compared with strength-trained athletes

Introduction Abuse of anabolic-androgenic steroids (AAS) has been linked to a variety of different cardiovascular (CV) side effects, but still the clinical effects of AAS abuse on CV risk are not clear. The aim of this study was to assess the CV phenotype of a large cohort of men with long-term AAS use compared with strength-trained athletes without AAS use. Methods Fifty one strength-trained men with >= 3 years of AAS use was compared with twenty one strength-trained competing athletes. We verified substance abuse and non-abuse by blood and urine analyses. The participants underwent comprehensive CV evaluation including laboratory analyses, 12-lead ECG with measurement of QT dispersion, exercise ECG, 24 h ECG with analyses of heart rate variability, signal averaged ECG, basic transthoracic echocardiography, and coronary computed tomography angiography (CCTA). Results Hemoglobin levels and hematocrit were higher among the AAS users compared with non-users (16.8 vs. 15.0 g/dl, and 0.50% vs. 0.44%, respectively, both p < 0.01) and HDL cholesterol significantly lower (0.69 vs. 1.25 mmol/L, p < 0.01). Maximal exercise capacity was 270 and 280 W in the AAS and the non-user group, respectively (p = 0.04). Echocardiography showed thicker intraventricular septum and left ventricular (LV) posterior wall among AAS users (p < 0.01 for both), while LV ejection fraction was lower (50 vs. 54%, p = 0.02). Seven AAS users (17%) had evidence of coronary artery disease on CCTA. There were no differences in ECG measures between the groups. Conclusions A divergent CV phenotype dominated by increased CV risk, accelerated coronary artery disease, and concentric myocardial hypertrophy was revealed among the AAS users.

Automated summary

This study compared the cardiovascular phenotypes of strength-trained men with long-term use of AAS and athletes without AAS use. The results showed that AAS users had higher hematocrit and hemoglobin levels, lower HDL cholesterol levels, slightly lower maximal exercise capacity, thicker intraventricular septum and left ventricular posterior wall, and lower LV ejection fraction compared to non-users. Furthermore, 17% of AAS users showed evidence of coronary artery disease. These findings indicate a divergent cardiovascular profile associated with increased cardiovascular risk among AAS users.