Long-Term Anabolic-Androgenic Steroid Use Linked to Myocardial Dysfunction and Atherosclerosis

Long-term use of anabolic-androgenic steroids increases risks for decreased left ventricular diastolic function and increased coronary plaque volume.

Long-term users of anabolic-androgenic steroids (AAS) are at an increased risk for myocardial dysfunction and accelerated coronary atherosclerosis, according to new research published in Circulation.

With an estimated 2.9 to 4 million Americans having used supraphysiologic doses of illicit AAS, Aaron L. Baggish, MD, MPH, of the Massachusetts General Hospital and Harvard Medical School, Boston, and fellow researchers sought to examine the long-term cardiovascular associations of these drugs. Their cross-sectional cohort study included 140 experienced male weightlifters (aged 34-54 years), 86 of whom indicated at least 2 years of cumulative lifetime AAS use vs 54 who reported not using AAS.

The researchers used transthoracic echocardiography and coronary computed tomography angiography to evaluate 3 primary outcome measures: left ventricular (LV) systolic function (LV ejection fraction [EF]), LV diastolic function, and coronary atherosclerosis.

Results suggested that when compared with nonusers, AAS users experienced reduced LV systolic function (mean LVEF, 52±11% vs 63±8%; P <.001) and diastolic function (early relaxation velocity, 9.3±2.4 cm/s vs 11.1±2 cm/s; P <.001).

At the time of evaluation, current AAS users (n=58) compared with users currently off the drug (n=28) had significantly reduced LV systolic function (LVEF, 49± 10% vs 58±10%; P <.001) and diastolic function (early relaxation velocity, 8.9±2.4 cm/s vs 10.1±2.4 cm/s; P =.035).

Coronary artery plaque volume was increased in AAS users vs nonusers (median, 3 mL3 vs 0 mL3; P =.012), and lifetime AAS dose was significantly linked with coronary atherosclerotic burden. For the latter finding, there was a 0.6 standard deviation unit increase in plaque volume rank for each 10-year increase in cumulative AAS use duration (P =.008).

“These findings may inform public health initiatives to curb drug exposure and provide clinicians with information that will translate into improved patient care,” the researchers concluded.

The researchers added that clinicians should consider the possibility of cardiotoxicity as result of long-term AAS use in the differential diagnosis if they encounter young or middle-aged men exhibiting evidence of unexplained LV dysfunction or premature coronary artery disease.

“It is notable that [approximately] 80% of contemporary AAS users are simply recreational weightlifters rather than competitive athletes, and thus the possibility of AAS use should be considered even in individuals who do not identify themselves as athletes.”

Disclosures:  Dr Hoffman reports receiving grants from HeartFlow and KOWA, and Dr Pope reports having received expert witness fees for cases involving anabolic-androgenic steroid use from the McNeil, Leddy, & Sheahan Law Firm and the US District Attorney for Eastern New York. 

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Baggish AL, Weiner RB, Kanayama G, et al. Cardiovascular toxicity of illicit anabolic-androgenic steroid use. Circulation. 2017;135:1991-2002. doi:10.1161/circulationaha.116.026945