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Androgenic Anabolic Steroid Abuse and the Cardiovascular System

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Doping in Sports: Biochemical Principles, Effects and Analysis

Part of the book series: Handbook of Experimental Pharmacology ((HEP,volume 195))

Abstract

Abuse of anabolic androgenic steroids (AAS) has been linked to a variety of different cardiovascular side effects. In case reports, acute myocardial infarction is the most common event presented, but other adverse cardiovascular effects such as left ventricular hypertrophy, reduced left ventricular function, arterial thrombosis, pulmonary embolism and several cases of sudden cardiac death have also been reported. However, to date there are no prospective, randomized, interventional studies on the long-term cardiovascular effects of abuse of AAS. In this review we have studied the relevant literature regarding several risk factors for cardiovascular disease where the effects of AAS have been scrutinized:

(1) Echocardiographic studies show that supraphysiologic doses of AAS lead to both morphologic and functional changes of the heart. These include a tendency to produce myocardial hypertrophy (Fig. 3), a possible increase of heart chamber diameters, unequivocal alterations of diastolic function and ventricular relaxation, and most likely a subclinically compromised left ventricular contractile function. (2) AAS induce a mild, but transient increase of blood pressure. However, the clinical significance of this effect remains modest. (3) Furthermore, AAS confer an enhanced pro-thrombotic state, most prominently through an activation of platelet aggregability. The concomitant effects on the humoral coagulation cascade are more complex and include activation of both pro-coagulatory and fibrinolytic pathways. (4) Users of AAS often demonstrate unfavorable measurements of vascular reactivity involving endothelial-dependent or endothelial-independent vasodilatation. A degree of reversibility seems to be consistent, though. (5) There is a comprehensive body of evidence documenting that AAS induce various alterations of lipid metabolism. The most prominent changes are concomitant elevations of LDL and decreases of HDL, effects that increase the risk of coronary artery disease. And finally, (6) the use of AAS appears to confer an increased risk of life-threatening arrhythmia leading to sudden death, although the underlying mechanisms are still far from being elucidated. Taken together, various lines of evidence involving a variety of pathophysiologic mechanisms suggest an increased risk for cardiovascular disease in users of anabolic androgenic steroids.

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Acknowledgements

The editorial assistance of Signe T. Nøsterud is highly appreciated. We are indebted to Ms Birgit Skjervik for excellent assistance with graphics and artwork, and we warmly thank Professor Egil Haug for critical review of the manuscript.

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  1. Chief Physician/Senior Cardiologist, Oslo University Hospital – Aker, Trondheimsveien 235, 0514-Oslo University Hospital, Oslo, Norway

    Paul Vanberg

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  1. Sportbiochemie Dresden, Institut für Dopinganalytik und, Dresdner Straße 12, Kreischa, 01731, Germany

    Detlef Thieme

  2. Gamle Trondheimsvei 39, Hagan, 1481, Norway

    Peter Hemmersbach

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Vanberg, P., Atar, D. (2010). Androgenic Anabolic Steroid Abuse and the Cardiovascular System. In: Thieme, D., Hemmersbach, P. (eds) Doping in Sports: Biochemical Principles, Effects and Analysis. Handbook of Experimental Pharmacology, vol 195. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-79088-4_18

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