Diminished cholesterol efflux mediated by HDL and coronary artery disease in young male anabolic androgenic steroid users

Abstract

Background and aims: Anabolic androgenic steroids (AAS) have been associated with coronary artery disease (CAD). AAS abuse leads to a remarkable decrease in high-density lipoprotein (HDL) plasma concentration, which could be a key factor in the atherosclerotic process. Moreover, not only the concentration of HDL, but also its functionality, plays a pivotal role in CAD. We tested the functionality of HDL by cholesterol efflux and antioxidant capacity. We also evaluated the prevalence of CAD in AAS users. Methods: Twenty strength-trained AAS users (AASU) age 29 ± 5 yr, 20 age-matched strength-trained AAS nonusers (AASNU), and 10 sedentary controls (SC) were enrolled in this cross-sectional study. Functionality of HDL was evaluated by 14 C-cholesterol efflux and the ability of HDL in inhibiting LDL oxidation. Coronary artery was evaluated with coronary computed tomography angiography. Results: Cholesterol efflux was lower in AASU compared with AASNU and SC (20 vs. 23 vs. 24%, respectively, p < 0.001). However, the lag time for LDL oxidation was higher in AASU compared with AASNU and SC (41 vs 13 vs 11 min, respectively, p < 0.001). We found at least 2 coronary arteries with plaques in 25% of AASU. None of the AASNU and SC had plaques. The time of AAS use was negatively associated with cholesterol efflux. Conclusions: This study indicates that AAS abuse impairs the cholesterol efflux mediated by HDL. Long-term AAS use seems to be correlated with lower cholesterol efflux and early subclinical CAD in this population.

Anabolic Steroids and Cardiovascular Outcomes: The Controversy

“…However, this study was limited to a short period of two months among a small group of 267 athletes. In 2019, three studies supported the claim that AS use was related to dyslipidemia [15][16][17]. Rosca et al conducted a study in rats and affirmed an increase in triglycerides and LDL with a decrease in HDL in plasma [15].…”

Increased concentration of 7-ketocholesterol and 7β-hydroxycholesterol in HDL from young anabolic androgenic steroid users

“…This response may contribute to the lower ability of HDL in removing cell cholesterol and trigger a higher pro-oxidant and pro-in ammatory effect in young male under AAS abuse. In fact, we previously found a diminished cholesterol e ux mediated by HDL and coronary artery disease in young male AAS users (12).…”

“…This is a subanalysis from a previous cross-sectional study (12). We evaluated a subgroup of 18 participants (29 ± 5 year): six AAS users (AASU), six AAS nonusers (AASNU) and six sedentary control men (SC).…”

“…Both groups (AASU and AASNU) were recreational weightlifters or amateur bodybuilding athletes who were recruited from gymnasiums. The inclusion and exclusion criteria were previously described (12).…”

“…Recent studies show the presence of subclinical coronary arterial disease (11,12) and diminished cholesterol e ux capacity mediated by high-density lipoprotein (HDL) in young AAS users (12). Increased oxysterols may be one of the mechanisms involved in the lower HDL functionality in young AAS users.…”