Cardiovascular Toxicities of Performance-Enhancing Substances in Sports

Abstract

Athletes commonly use drugs and dietary supplements to improve athletic performance or to assist with weight loss. Some of these substances are obtainable by prescription or by illegal means; others are marketed as supplements, vitamins, or minerals. Nutritional supplements are protected from Food and Drug Administration regulation by the 1994 US Dietary Supplement Health and Education Act, and manufacturers are not required to demonstrate proof of efficacy or safety. Furthermore, the Food and Drug Administration lacks a regulatory body to evaluate such products for purity. Existing scientific data, which consist of case reports and clinical observations, describe serious cardiovascular adverse effects from use of performance-enhancing substances, including sudden death. Although mounting evidence led to the recent ban of ephedra (ma huang), other performance-enhancing substances continue to be used frequently at all levels, from elementary school children to professional athletes. Thus, although the potential for cardiovascular injury is great, few appropriately designed studies have been conducted to assess the benefits and risks of using performance-enhancing substances. We performed an exhaustive OVID MEDLINE search to Identify all existing scientific data, review articles, case reports, and clinical observations that address this subject. In this review, we examine the current evidence regarding cardiovascular risk for persons using anabolic-androgenic steroids including 2 synthetic substances, tetrahydrogestrinone and androstenedione (andro), stimulants such as ephedra, and nonsteroidal agents such as recombinant human erythropoietin, human growth hormone, creatine, and beta-hydroxy-beta-methylbutyrate.

Perceptions, attitudes and knowledge of secondary school students regarding the use of the forbidden stimulant substances in sports

“…Вјероватно узрок оваквог мишљења ученика јесте и недовољна информисаност по питању конзумације допинга у спорту и негативним посљедицама које он носи. Значај проблема допинга је базиран на више чињеница, а прије свега на штетним ефектима на поједине органске системе које изазива коришћење допинг супстанци (Mougios, 2001;Parssinen, & Sepapala, 2002;Payne, Kotwinski, & Montgomery, 2004;Hartgens, & Kuipers, 2004;Dhar, Stout, Link, Homoud, Weinstock, & Estes 2005., Deligiannis, Björnstad, Carre, Heidbüchel, Kouidi, & Panhuyzen-Goedkoop, 2006Hasson, Salem, & Sayed, 2009).…”

Drug-Induced Cardiomyopathies

“…According to clinical data, self-reported rates of abuse in bodybuilders and powerlifters to enhance performance range from 29% to 67% (Curry and Wagman 1999;Achar et al 2010). Also, there is now widespread use among non-competitive bodybuilders, recreational athletes, and those who simply desire an improved physique (Dhar et al 2005). Thus, the risk of incidence of adverse effects in general population is relatively high.…”

“…Other studies reveal increased incidence of diastolic dysfunction, greater left ventricular posterior wall thickness, and greater left ventricular end-diastolic dimensions. In this setting, sudden death may have been caused by vasospasm potentiated by diastolic dysfunction-mediated ischemia (Dhar et al 2005). Cardiomyopathy, cardiomegaly, and biventricular dilatation induced by anabolic-androgenic steroids can occur as a result of remodelling after myocyte injury and have been noted to be reversible after discontinuation of anabolic-androgenic steroids administration (Hausmann et al 1998).…”

A Review of Erythropoietin Abuse: An Analysis of Effectiveness and Safety in Exercise

“…Despite these potential endurance benefits, there are known complications with RhEPO use. Serious adverse effects may consist of polycythemia, myocardial infarction, stroke, hypertension, congestive heart failure, seizure, embolism, and death [9,[11][12][13][14][15]. The mechanism behind many of these complications are possibly related to miscalculation of RhEPO doses as well as increased levels of Hb and Hct.…”

“…The mechanism behind many of these complications are possibly related to miscalculation of RhEPO doses as well as increased levels of Hb and Hct. Dehydration during an endurance event coupled with hyper viscosity and elevated blood pressure due to elevated Hb and Hct levels may attribute to the potentially severe adverse events [11][12][13][14][15]. As a result of the potential athletic advantage and harm, the World Anti-Doping Agency (WADA) has added RhEPO or any analog to its list of prohibited substances.…”