Atrial fibrillation and anabolic steroid abuse

Lau, Dennis H.; Stiles, Martin K.; John, Bobby; Shashidhar,; Young, Glenn D.; Sanders, Prashanthan

doi:10.1016/j.ijcard.2006.11.199

Cited by 74 publications

(31 citation statements)

References 6 publications

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“…There may be several potential mechanism how TRT worsen the cardiometabolic parameters. First, supraphysiological androgen dosages, namely periodic depot injections, may cause the adverse effect [45,46]. However, our results show that both daily transdermal and triweekly depot injections of TRT have similar cardiometabolic effects in this patient group.…”

Section: Discussionmentioning

confidence: 72%

Endothelial dysfunction, insulin resistance and inflammation in congenital hypogonadism, and the effect of testosterone replacement

Sönmez¹,

Haymana²,

Aydoğdu³

et al. 2015

Endocr J

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Patients with hypogonadism not only present with poor libido, loss of energy, muscle atrophy and depression but also with chronic metabolic disorders such as dyslipidemia, obesity, hypertension and type 2 diabetes mellitus (T2DM) [1][2][3] and increased mortality [4]. The dysmetabolic features of hypogonadism are present even in the very young age, in patients with congenital hypogonadotrophic hypogonadism (CHH) [5].Endothelial dysfunction, insulin resistance and inflammation in congenital hypogonadism, and the effect of testosterone replacement (TRT) is not clear. We investigated the presence of inflammation, insulin resistance and endothelial dysfunction in an unconfounded population of congenital hypogonadotrophic hypogonadism (CHH) and the effect of TRT on these subjects. A total of 60 patients with CHH (mean age 21.82±2.22 years) and 70 healthy control subjects (mean age 21.32±1.13 years) were enrolled. The demographic parameters, Asymmetric dimethylarginine (ADMA), TNF-like weak inducer of apoptosis (TWEAK), high sensitive C reactive protein (hs-CRP) and homeostatic model assessment of insulin resistance (HOMA-IR) levels were measured before and after TRT. The patients had higher Waist Circumferences (WC) (p=0.009), Diastolic Blood Pressures (p=0.02), Triglycerides (p=0.03), ADMA, insulin and HOMA-IR levels (p<0.001 for all) and lower TWEAK levels (p<0.001), compared to the healthy controls. After 5.56 ± 2.04 months of TRT, the patients had significantly elevated systolic blood pressures (p=0.01), body mass indexes and WC (p<0.001 and p=0.001 respectively) and decreased total and HDL cholesterol levels (p=0.032 and p<0.001 respectively). ADMA levels significantly increased (p=0.003), while the alterations in TWEAK, hsCRP and HOMA-IR were not significant. The results of the present study show that endothelial dysfunction, inflammation and insulin resistance are prevalent even in the very young subjects with CHH, who have no metabolic or cardiac problems at present. This increased cardiometabolic risk however, do not improve but even get worse after six months of TRT. Long term follow-up studies are warranted to investigate the unfavorable cardiometabolic effects of TRT. Key words: Endothelial dysfunction, Insulin resistance, Inflammation, HypogonadismHowever, whether the testosterone replacement treatment (TRT) improves the metabolic and cardiovascular risks of patients with hypogonadism is not clear. Several reports mention favorable metabolic effects of TRT [6-9] while others do not confirm these data [10][11][12][13]. The meta-analyses show no significant metabolic benefit but a tendency towards increased cardiovascular events due to TRT [14][15][16]. Meanwhile, a prospective cohort of elderly hypogonadal men was recently terminated due to the increased cardiovascular mortality in the testosterone replacement arm [13]. There may be several reasons for the inconsistencies of the previous reports. Most of these studies were per-

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Section: Discussionmentioning

confidence: 72%

Endothelial dysfunction, insulin resistance and inflammation in congenital hypogonadism, and the effect of testosterone replacement

Sönmez¹,

Haymana²,

Aydoğdu³

et al. 2015

Endocr J

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“…In contrast, supraphysiologic doses of testosterone and other anabolic androgen steroids may facilitate ventricular arrhythmias by increasing QTc interval and dispersion [45] and by predisposing to reentry mechanism [46]. Androgen misuse has been also associated with episodes of atrial fibrillation [47,48]. Nevertheless, the possibility of a protective effect of testosterone against atrial fibrillation [49,50] has been contradicted by both a meta-analysis which included middle-aged and older men [51] and by animal research [52] associating testosterone supplementation with higher occurrence of atrial fibrillation.…”

mentioning

confidence: 99%

Androgens in cardiac fibrosis and other cardiovascular mechanisms

Čulić

2015

International Journal of Cardiology

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“…24,25 Fluid shifts and electrolyte abnormalities occurring during vigorous exercise may also trigger AF, 26 whereas the use of illicit drugs may be associated with the arrhythmia. 27 Nevertheless, it is essential in the work-up of the arrhythmia to exclude any …”

Section: Pathophysiology Of Atrial Fibrillation In Athletesmentioning

confidence: 99%

Endurance Sport Activity and Risk of Atrial Fibrillation – Epidemiology, Proposed Mechanisms and Management

Fragakis

Vicedomini

Pappone

2011

Arrhythmia &Amp; Electrophysiology Review

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Although atrial fibrillation (AF) is considered the most common arrhythmia in clinical practice, its prevalence is relatively low in the young and middle-aged, ranging from 0.5 % in men below 40 years to 1 % by 60 years.1,2 Regular exercise is proposed as a powerful tool for the primary and secondary prevention of cardiovascular disease, reducing most of the risk factors that predispose to AF, such as hypertension, diabetes mellitus, coronary artery disease and obesity.3,4 However, there is growing evidence that long-term endurance exercise may increase the risk of developing AF, with a reported 2-10 times greater prevalence in athletes and those who are involved in long-term sport participation. 5Why athletes should be susceptible to AF is an issue of ongoing debate. Several mechanisms underlying the association between exercise and AF have been proposed but they remain speculative.It is of interest that adaptations such as sinus bradycardia and atrioventricular node disturbances, which are generally considered benign and reversible after a short period of detraining, have been considered by some investigators as a reason for AF development in elderly athletes. 6 It is clear that AF in athletes has some differences in cause, clinical presentation and treatment strategies compared with the general population. The aim of this short review is to present the existing data about the epidemiology of AF in athletes and those engaged in long-term endurance sport practice, to analyse the pathophysiological mechanisms that connect AF with exercise, and finally to discuss the existing treatment options. Prevalence and Incidence of Atrial Fibrillation in Endurance Sport Practice and in Vigorous Physical ActivityThe prevalence of AF in the athletic community varies considerably dependent on the age and the number of years of training of the subjects. It is essential to make a distinction between studies including young athletes with only a few years of training and those with middle-aged or older individuals practising sports for many years.Whereas the incidence of AF in young athletes appears similar to that observed in the general population, in older athletes an increased incidence of AF is reported. 6,[8][9][10][11][12][13][14][15] Furlanello et al. 16 and Pelliccia et al. 17 reported a low rate of AF (0.2 % and 0.3 %, respectively), no different from that observed in the general population. However, both studies included exclusively young athletes with relatively fewer years of training. In contrast, several other studies of middle-aged athletes, who were engaged in sport training for many years, demonstrated an increased prevalence of AF compared with the rest of the population (see Table 1). A common characteristic among all these studies was that the participating athletes were predominately male and they were involved in endurance sports. The prevailing pattern of AF was the so-called vagal lone AF, as it was usually encountered in relatively young individuals (<60 years old) without clinical or echocardiographic e...

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Atrial fibrillation and anabolic steroid abuse

Cited by 74 publications

References 6 publications

Endothelial dysfunction, insulin resistance and inflammation in congenital hypogonadism, and the effect of testosterone replacement

Endothelial dysfunction, insulin resistance and inflammation in congenital hypogonadism, and the effect of testosterone replacement

Androgens in cardiac fibrosis and other cardiovascular mechanisms

Endurance Sport Activity and Risk of Atrial Fibrillation – Epidemiology, Proposed Mechanisms and Management

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