Anabolic‐Androgenic steroid abuse in weight lifters: Evidence for activation of the hemostatic system

Abstract

Anabolic-androgenic steroid abuse has recently been linked with acute vascular events in athletes. To date, the relationship between steroid abuse and the potential for cardiovascular disease has been considered almost exclusively in terms of lipid metabolism. However, recent reports of thrombosis in androgen abusing athletes with no evidence of atherosclerosis suggests the hypothesis that thrombosis risk in such athletes could be mediated through androgen induced abnormalities of coagulation. To determine if anabolic-androgenic steroid abuse in weight lifters is associated with an activation of the hemostatic system we studied forty-nine weight lifters recruited through advertisements. History of androgen use or abstinence was confirmed via urine assays. Plasma was assayed for clotting and fibrinolytic activity by measuring thrombin/antithrombin complexes (TAT), prothrombin fragment 1 + 1 (F1 + 2), and D-dimers (D-di); markers of the endothelial based fibrinolytic components were assayed by measuring tissue plasminogen activator antigen (t-PA Ag) and its inhibitor (PAI-1); finally, the activity of antithrombin III, protein C, and protein S were measured. Abnormally high concentrations of TAT complexes were noted in 16% of our confirmed steroid using weight lifters compared to 6% of our confirmed nonusers (P = .01). Steroid users also demonstrated abnormally high concentrations of F1 + 2 and D-dimers when compared to nonusers (44 vs. 24%, P < .001, and 9 vs. 0%, respectively). Non-steroid users were more likely to have elevated levels of t-PA Ag and PAI-1 than our steroid using weight lifters (both P < .001). The activities of antithrombin III and protein S were more likely to be higher in users compared to nonusers (22 vs. 6%, P = .005; 19 vs. 0%, respectively). Some anabolic-androgenic steroid using weight lifters have an accelerated activation of their hemostatic system as evidence by increased generation of both thrombin and plasmin. These changes could reflect a thrombotic diatheses that may contribute to vascular occlusion reported in young athletes using these drugs. The predictive value of these coagulation abnormalities in terms of risk of thrombosis to individual steroid using weight lifters or the population as a whole remains to be studied.

Adverse cardiovascular effects of anabolic steroids: pathophysiology imaging

“…It has been shown in many oncological and myocardial remodelling studies that radiotracers based on RGD can be applied targeting avb3 integrin [42,43]. One recent report showed that 18 F-RGD PET can show atherosclerotic changes in apoE ) ⁄ ) mice [44]. In that report, quantified measures of 18 F-RGD uptake were correlated with 18 F-FDG PET measures.…”

“…VCAM-1-targeting nanoparticles have been used for signal enhancement in atheromatous arteries of apoE ) ⁄ ) mice, and MRI showed promising results [40]. Recently, the same group labelled the same tetrameric peptide with positron emitter 18 Fluoride for PET imaging and was able to demonstrate early atherosclerotic changes in apoE ) ⁄ ) mice [41].…”

“…According to the world anti-doping agency report in 2008, AAS were the most commonly identified prohibited drugs among all, comprising 59% of all reported findings. According to a study from 1995, it was suggested that nearly 70% of elite US powerlifters had abused AAS [18]. Unfortunately, AAS abuse occurs frequently not only amongst professional athletes, but also in the general population, particularly high school students.…”

“…18 F-fluorodeoxyglucose ( 18 F-FDG) positron emission tomography (PET) has been studied in a notable number of investigations and has been shown to correlate with the macrophage density in atherosclerotic plaques in humans and in animal models [29]. Additionally, 18 F-FDG PET depicts MI subsequent to coronary atherosclerosis. Figure 1 shows a whole body cardiac gated 18 F-FDG PET ⁄ CT image of a male bodybuilder with abdominal aortic calcification ( Fig.…”

“…Additionally, 18 F-FDG PET depicts MI subsequent to coronary atherosclerosis. Figure 1 shows a whole body cardiac gated 18 F-FDG PET ⁄ CT image of a male bodybuilder with abdominal aortic calcification ( Fig. 1a) with more extensive FDG uptake in aortic plaques (Fig.…”