Recreational athletes who take anabolic steroids to build muscle must probably expect considerable long-term cardiac damage. According to a recent observational study, both systolic and diastolic ventricular function are severely impaired by regular use (Circulation 2017; 135:1991-2002).
In addition, the anabolic drug users examined already showed the first signs of coronary heart disease.
“Doctors who detect unexplained left ventricular dysfunction or signs of coronary heart disease in men of younger to middle age should therefore consider cardiotoxicity induced by anabolic steroids as a differential diagnosis,” the authors of the study advise Dr. Aaron Baggish of Massachusetts General Hospital in Boston.
Since the 1980s, the intake of anabolic steroids – the best-known representative of so-called anabolic steroids – has been widespread among athletes. The people who would have started taking it at that time would now reach an age at which the late effects of long-term use would become visible, Baggish and colleagues point out.
The majority of consumers are recreational athletes
The illegal consumption of synthetically produced testosterone preparations is by no means limited to competitive sports: around 80 percent of users are recreational athletes. In Germany, an estimated 200,000 people take anabolic steroids.
As the authors of the study emphasize, they did not examine any competitive athletes in their study. Rather, it was 140 men aged between 34 and 54 who lifted weights in their free time.
To improve performance, 86 participants took anabolic-androgenic steroids over a period of at least two years, 58 of them still did so at the time of the study. 54 of the weightlifters did not use anabolic steroids and served as controls.
41 of the participants consuming anabolic steroids (71 percent) already had a limited pumping function of the left ventricle (left ventricular ejection fraction (EF) <52 percent); in contrast, only two persons were affected in the controls.
In general, EF was significantly lower among anabolic users than among controls (52 ± 11 percent vs. 63 ± 8 percent; p<0.001). The ejection fraction of the weight lifters who had stopped taking it was again normal. The authors assume that the pumping function of the left ventricle can recover as soon as intake is stopped.
Partially irreversible damage
Diastolic function, on the other hand, remained reduced even among participants who had already stopped taking anabolic steroids (early left ventricular relaxation rate 10.1 vs. 11.1 cm/s in controls). The researchers conclude from this finding that steroid intake probably caused permanent, non-reversible damage.
Not surprisingly, the anabolic effect of the testosterone preparations also led to an enlargement of the left ventricle. The extent of hypertrophy correlated with systolic and diastolic ventricular function.
In addition to these obvious effects on heart muscle function, anabolic steroids also seem to accelerate the development of atherosclerosis and coronary heart disease. CT angiography of anabolic steroids showed more frequent coronary plaques and the lifelong dose of anabolic steroids correlated strongly with the extent of the atherosclerotic findings.