Are the cardiac effects of anabolic steroid abuse in strength athletes reversible?

Abstract

Objective: To investigate the reversibility of adverse cardiovascular effects after chronic abuse of anabolic androgenic steroids (AAS) in athletes. Methods: Doppler echocardiography and cycle ergometry including measurements of blood pressure at rest and during exercise were undertaken in 32 bodybuilders or powerlifters, including 15 athletes who had not been taking AAS for at least 12 months (ex-users) and 17 currently abusing AAS (users), as well as in 15 anabolic-free weightlifters. Results: Systolic blood pressure was higher in users (mean (SD) 140 (10) mm Hg) than in ex-users (130 (5) mm Hg) (p , 0.05) or weightlifters (125 (10) mm Hg; p , 0.001). Left ventricular muscle mass related to fat-free body mass and the ratio of mean left ventricular wall thickness to internal diameter were not significantly higher in users (3.32 (0.48) g/kg and 42.1 (4.4)%) than in ex-users (3.16 (0.53) g/kg and 40.3 (3.8)%), but were lower in weightlifters (2.43 (0.26) g/kg and 36.5 (4.0)%; p , 0.001). Left ventricular wall thickness related to fat-free body mass was also lower in weightlifters, but did not differ between users and ex-users. Left ventricular wall thickness was correlated with a point score estimating AAS abuse in users (r = 0.49, p , 0.05). In all groups, systolic left ventricular function was within the normal range. The maximum late transmitral Doppler flow velocity (Amax) was higher in users (61 (12) cm/s) and ex-users (60 (12) cm/s) than in weightlifters (50 (9) cm/s; p , 0.05 and p = 0.054). Conclusions: Several years after discontinuation of anabolic steroid abuse, strength athletes still show a slight concentric left ventricular hypertrophy in comparison with AAS-free strength athletes.

A associação de esteroide anabolizante ao treinamento físico aeróbio leva a alterações morfológicas cardíacas e perda de função ventricular em ratos

“…Studies have shown increase of cardiac mass in AAS users (9) and in animal models (7,21) , and this increase many times associated with greater cardiac fibrosis (12,21) . The CH induced by the AAS may occur by its interaction with nuclear receptors, directly acting in the DNA increasing the protein synthesis or, by affecting specific enzymes, ion flow and structural matrix in the myocardium as well (25) .…”

“…Further studies (10,11) , observed harm of the diastolic function in weight lifters who used AAS compared to the ones who did not use them. Investigations with ex-users observed that their effects on the mass of the left ventricle and ventricular function persisted even after one year with the drug abstinence (12) . However, the great majority of the investigations which study the cardiac effects of the AAS are carried out with strength or Power athletes, but athletes from aerobic modalities also make use of AAS (13) trying to minimize the catabolic actions induced by training, increase the protein synthesis and increase disposition to training due to actions on the central nervous system (14) .…”

Comparison of Left Atrial Function in Long-Term Anabolic/Androgenic Steroid Users versus Nonuser Bodybuilders by Using Two- Dimensional Speckle-Tracking Echocardiography

“…Although standard Doppler echocardiography has been widely used to distinguish athlete's heart from pathological LV hypertrophy, recent studies indicate that Doppler tissue imaging techniques, in particular PW-TDI, are also useful in assessing myocardial systolic and diastolic function and differentiating pathological ventricular hypertrophy from the physiological one (7,34,35) . Shan et al, comparing Doppler tissue imaging and histological findings in patients affected by coronary artery disease, demonstrated that Sm and Em are strongly dependent on the number of myocytes, myocardial b-adrenergic receptor density, and the amount of interstitial fibrosis (36) .…”

Reposição hormonal e exercício físico no tratamento da insuficiência cardíaca: revisão sistemática

“…However, this intervention has not been synergically assessed in relation to exercise. On the other hand, abusive anabolic androgens use, common among athletes, causes worsening of heart function, leading to diastolic dysfunction due to increase of left ventricular mass and myocardial hypertrophy (26) . 2.…”