Cardiovascular effects of doping substances, commonly prescribed medications and ergogenic aids in relation to sports: a position statement of the sport cardiology and exercise nucleus of the European Association of Preventive Cardiology

Abstract

The use of substances and medications with potential cardiovascular effects among those practicing sports and physical activity has progressively increased in recent years. This is also connected to the promotion of physical activity and exercise as core aspects of a healthy lifestyle, which has led also to an increase in sport participation across all ages. In this context, three main users’ categories can be identified, (i) professional and amateur athletes using substances to enhance their performance, (ii) people with chronic conditions, which include physical activity and sport in their therapeutic plan, in association with prescribed medications, and (iii) athletes and young individuals using supplements or ergogenic aids to integrate their diet or obtaining a cognitive enhancement effect. All the substances used for these purposes have been reported to have side effects, among whom the cardiovascular consequences are the most dangerous and could lead to cardiac events. The cardiovascular effect depends on the type of substance, the amount, the duration of use, and the individual response to the substances, considering the great variability in responses. This Position Paper reviews the recent literature and represents an update to the previously published Position Paper published in 2006. The objective is to inform physicians, athletes, coaches, and those participating in sport for a health enhancement purpose, about the adverse cardiovascular effects of doping substances, commonly prescribed medications and ergogenic aids, when associated with sport and exercise.

A case of pulmonary thromboembolism possibly associated with the use of creatine supplements

“…The auxiliary use of ergogenic aids by recreational and professional athletes can cause harmful side effects. 3 Thrombotic complication, one of the significant complications, is well known to be associated with use of androgenic anabolic steroids and erythropoietin. 3 …”

“… 3 Thrombotic complication, one of the significant complications, is well known to be associated with use of androgenic anabolic steroids and erythropoietin. 3 …”

“…Creatine monohydrate induces an osmotic effect by increasing the concentration of intracellular creatine, allowing water to move into the muscle. 3 Dehydration is a known risk factor for VTE as it increases blood viscosity. 5 The creatine supplements likely promoted dehydration during intense workouts with profuse sweating.…”

“…A new position statement from the European Association of Preventive Cardiology emphasizes that creatine use should be monitored carefully until more definitive data are obtained. 3 Adherence to the recommended dose and to stay hydrated when exercising seems important.…”

“… 1 Creatine is a common ingredient of nutritional supplements and ergogenic aids for athletes. 2 , 3 It is widely used without caution, although there is some concern over the possible risk of VTE from creatine intake. 3 , 4 We present a case of new‐onset bilateral pulmonary embolism (PE) and deep vein thrombosis (DVT), possibly associated with excessive creatine supplement intake and dehydration, in a previously healthy young man.…”