Long-term use of anabolic-androgenic steroids (AAS) has serious consequences for the heart, according to a new study that has been following weightlifters for nearly 10 years.
The study, published today (Tuesday) in European Heart Journal Cardiovascular Imaging, found that men who used anabolic steroids while engaged in strength training had sustained thickening of the heart’s left ventricular wall. In addition, the heart became worse at pumping blood around the body due to the left ventricle being unable to contract enough to push the blood out effectively, or to relax enough between beats to allow the heart to fill with blood again.
Dr Vibeke M. Almaas, a senior consultant at ProCardio Center for Research Based Innovation, Department of Cardiology, Rikshospitalet, Oslo University Hospital, Norway, who led the study, said: “We found that continued use of anabolic steroids among adult and middle-aged male strength athletes, even at lower dosages, was associated with a persistent thickening of the heart muscle, impaired contractions and worsening of the heart’s ability to relax. As many as 17% of those who continued using AAS had severely reduced heart function. However, this could be reversed if the men stopped using anabolic steroids and continued to abstain from them over the long term.”
The findings add to evidence of harm caused by non-medical use of anabolic steroids. It is well-known that users develop a dependence on AAS, and that AAS use is linked to metabolic, hormonal and liver damage. There is growing evidence that it is also linked to adverse effects on several other organs, and that the heart and blood vessels are particularly vulnerable. However, until now there have been few studies that have followed anabolic steroid users for a long time.
It was still unclear whether the cardiac abnormalities demonstrated in previous studies, including increased heart muscle thickness and reduced cardiac function, progress with continued exposure or whether they improve with dose reduction or after cessation. To address this knowledge gap, we conducted a follow-up of our previously published group of male AAS users engaged in recreational strength training.”
Dr Vibeke M. Almaas, senior consultant, ProCardio Center for Research Based Innovation, Department of Cardiology, Rikshospitalet, Oslo University Hospital
Dr Almaas and her colleagues at the Oslo University Hospital invited 101 AAS users and 71 non-users who had taken part in the earlier study between 2017 and 2019 to join the follow-up study. Among those who re-enrolled in the study, 70 were AAS users, and 35 were non-users, who acted as the control group. Among those who had been users in the earlier study, 35 continued to use anabolic steroids, 15 had discontinued using them, 14 maintained abstinence, and six had relapsed.
In self-reported questionnaires and clinical interviews, the participants were asked about their medical history, including information on heart symptoms, cardiac arrest, the presence of coronary artery disease, the time they spent on strength and endurance training, and their use of AAS, including type of AAS, dosages, duration and whether they had discontinued. They also reported the heaviest weight they had lifted successfully at any point during their strength-training history.
The researchers asked about alcohol consumption, smoking and use of illicit drugs. They took blood and urine samples to measure levels of different hormones, and used echocardiography to image the heart.
Although many AAS users reported a reduction in their dosages since the start of the original study, the researchers found that this did not have any beneficial effects on the weightlifters’ hearts. Only stopping anabolic steroids completely and taking medication to treat high blood pressure made a difference.
The 15 men who had stopped using AAS showed a significant reduction in the heart muscle thickness at follow-up compared to when they entered the study (the baseline). This was measured as left ventricle mass indexed for body surface area (LVMI). LVMI reduced from 112 g/m2 to 91 g/m2, a 19% reduction, which matched the LVMI of men in the control group who did not use steroids. Their left ventricle systolic function, measured by ejection fraction (LVEF) – how much blood the left ventricle can pump out – also improved by 13%, correlating to an increase in LVEF from 48% to 54%. However, this did not match the LVEF of men in the control group, who had an LVEF of 60% at follow-up.
AAS users who did not receive medical treatment for high blood pressure had an eight percent deterioration of left ventricle systolic function from baseline to follow-up, whereas those who did receive hypertension treatment had an improvement in LVEF of 11%, but no improvement in heart muscle thickness.
“Discontinuation of AAS use was associated with a reduction in heart muscle thickening and improvements in cardiac function, suggesting that at least some of these adverse effects may be reversible after stopping, and may even become comparable with the non-users in the control group,” said Dr Almaas. “Antihypertensive therapy among ongoing AAS-users was associated with improved LV systolic function.”
Co-author, Dr Astrid Bjørnebekk, head of the Anabolic Androgenic Steroid Research Group at Oslo University Hospital, said: “Our findings underline the importance of continuing both preventive work and harm reduction efforts. Anabolic steroids have been prohibited in competitive sports for decades, and since 2013, non-medical use and possession have also been illegal in Norway. Despite this, national reports indicate continued use of performance- and appearance-enhancing drugs, and increasing interest in them.”
The study has several limitations. These include the small number of participants, not all of whom returned for the follow-up study, which could introduce bias; AAS use was self-reported over the period of the original and follow-up study and so could be subject to recall bias; information on treatment for high blood pressure was only available for the follow-up study; and lifestyle factors, stimulant use, high blood pressure or other health problems may have affected the results.
Source: