Elsevier

American Heart Journal

Volume 203, September 2018, Pages 49-56
American Heart Journal

Clinical Investigation
Cardiac systolic dysfunction in past illicit users of anabolic androgenic steroids

https://doi.org/10.1016/j.ahj.2018.06.010Get rights and content

Abstract

Background

Illicit use of anabolic androgenic steroids (AAS) is associated with left ventricle (LV) systolic dysfunction and increased LV mass (LVM), but whether these findings persist in former AAS users has yet to be elucidated. The objective was to assess LV systolic function, LVM and myocardial fibrosis in current and former illicit AAS users compared with non-users.

Methods

Community-based cross-sectional study among men, aged 18–50 years, involved in recreational resistance training. We included 37 current and 33 former illicit AAS users, geometric mean (95%CI), 30 (21; 44) months since AAS cessation, and 30 non-users as controls. We assessed myocardial function and structure using advanced echocardiography and cardiac MRI with late-gadolinium enhancement.

Results

Mean (SE) LV global longitudinal strain (GLS) was impaired in former AAS users compared with non-users, −16.7 (0.5) versus −18.2 (0.4) %, P < .05. Mean (SE) LV ejection fraction (EF) was decreased, 51 (1) versus 58 (1) %, P < .001 and LV GLS impaired, −14.5 (0.4)%, P < .001, in current AAS users compared with non-users. Measures of LVM were increased in current AAS users compared with the other two groups, P < .001. Plasma total testosterone was independently associated with reduced LVEF (P = .049) and increased LVM/body surface area (P = .005) in multivariate linear regressions. Focal myocardial fibrosis was not detected in any participants and diffuse myocardial fibrosis, assessed using post-contrast T1-mapping time, did not differ among the three groups.

Conclusions

Past illicit AAS use is associated with impaired LV GLS, suggesting subclinical cardiac systolic dysfunction years after AAS cessation.

Section snippets

Study design and participation criteria

Men, aged 18 to 50 years, involved in recreational resistance training, volunteered from the community to participate in this cross-sectional study from November 2014 to December 2015. We have previously described the study design, inclusion of participants and several procedures.14., 15., 16., 17. To minimize risk of selection bias, we did not use specific criteria regarding weekly hours of resistance training or duration nor extent of AAS abuse. Participants were allocated into three

Characteristics of participants

The study cohort comprised 37 ongoing AAS users, 33 former AAS users, and 30 non-users. Geometric mean (95%CI) number of weeks of accumulated duration of illicit AAS use did not differ between current users, 142 (100; 203) and former users, 112 (81; 154) (Table I). AAS dose ranges used by current and former AAS users are described elsewhere for each AAS compound.14 Mean (95%CI) elapsed duration since AAS discontinuation was 30 (21; 44) months among former users and in this group none reported

Discussion

The primary findings in this study were that both former and current illicit AAS users featured indices of decreased LV systolic function; manifested as impaired LV GLS in both former and current AAS users and lower LVEF in current AAS users. Only current use of AAS was associated with LV myocardial hypertrophy and diastolic dysfunction. We noted independent associations between increased plasma total testosterone and decreased LVEF and LV myocardial hypertrophy, but we did not detect

Conclusions

In conclusion, both current and former illicit AAS users displayed lower LV systolic function than non-users. LV mass was only increased in current AAS users. We noted independent associations between increased plasma testosterone and decreased LVEF and LV myocardial hypertrophy, but myocardial fibrosis was not detected in any participants using MRI-LGE. Longitudinal studies are warranted to further elucidate the clinical relevance of our findings.

Acknowledgements

The authors are grateful to all participants for their contribution to this study. Furthermore, we are thankful to the personnel in the endocrine research lab of Herlev Hospital for highly qualified technical assistance.

Contributors

Conception and design: JJR, CK, FG, MS. Acquisition of data: JJR, CK, MS, MLJ. Analysis of data: JJR, TK, PLM, LLP, TD. Interpretation of data: JJR, CK, FG, MS, CS, PLM, JF, PSU, MLJ, TK, LLP and TD. Drafting of manuscript: JJR. Revising manuscript of critically important intellectual content: JJR, CK, FG, MS, CS, PLM, JF, PSU, MLJ, TK, LLP and TD. Final approval of manuscript: JJR, CK, FG, MS, CS, PLM, JF, PSU, MLJ, TK, LLP and TD. All authors had full access to the data and agree to take

References (31)

  • W. Bartsch

    Interrelationships between sex hormone-binding globulin and testosterone, 5 alpha-dihydrotestosterone and oestradiol-17 beta in blood of normal men

    Maturitas

    (1980)
  • A.L. Baggish et al.

    Long-term anabolic-androgenic steroid use is associated with left ventricular dysfunction

    Circ Heart Fail

    (2010)
  • P.J. Angell et al.

    Anabolic steroid use and longitudinal, radial, and circumferential cardiac motion

    Med Sci Sports Exerc

    (2012)
  • A.L. Baggish et al.

    Cardiovascular toxicity of illicit anabolic-androgenic Steroid use

    Circulation

    (2017)
  • S. Baumann et al.

    Myocardial scar detected by cardiovascular magnetic resonance in a competitive bodybuilder with longstanding abuse of anabolic steroids

    Asian J Sports Med

    (2014)
  • Cited by (38)

    • Physiological and pathological cardiac adaptations to physical exercise

      2023, Athlete's Heart: A Multimodal Approach - From Physiological to Pathological Cardiac Adaptations
    • Applying insights from implementation and intervention science to improve the evidence base on image and performance-enhancing drugs (IPEDs) interventions

      2021, Performance Enhancement and Health
      Citation Excerpt :

      IPEDs, the most commonly studied of which are anabolic androgenic steroids (AAS), are associated with increasing risk of experiencing a range of side effects and harmful physical and psychological health outcomes that range from cosmetic to acute and chronic. These have been extensively summarised elsewhere (ACMD, 2010; McVeigh & Begley, 2017; Pope et al., 2014) but include concerns such as changes to cognitive function (Bjørnebekk et al., 2019), cardiovascular disease (Baggish et al., 2017; Rasmussen et al., 2018; Thiblin et al., 2015), reproductive dysfunction (Christou et al., 2017), blood-borne virus transmission (Hope et al., 2016), injection site injuries and infections (Hope et al., 2015), and dependence (Kanayama et al., 2009). Our understanding of the associations between IPED use and harm is still developing, but factors such as dosage, length of time that IPEDs are used for, and mode of administration appear important (Pope et al., 2014).

    View all citing articles on Scopus

    Declarations of interest: JJR and CK received unrestricted research grants from AntiDoping Denmark. MS, PLM, CS, MLJ, PSU, TK, TD, LLP, JF and FG have no conflicts of interest in relation to the present topic.

    Funding: This work was supported by AntiDoping Denmark (grant number: N/A), Research Foundation of Herlev Hospital (grant number: N/A), Danish Heart Foundation (grant number: 15-R99-A5797–22952), Faculty Scholarship from University of Copenhagen to JJR (grant number: N/A).

    Role of the funding source: The financial sources had no role in study design, conduction of study, statistical analyses, writing of manuscript or decision to publish the final version of manuscript.

    View full text