Non-ischemic Cardiomyopathy Secondary to Left Ventricular Hypertrophy due to Long-term Anabolic-androgenic Steroid Use in a Former Olympic Athlete

Abstract

Currently, the cardiovascular risk associated with the use of anabolic steroids is not well documented. Recent studies have shown that its use may potentiate the development of cardiac dysfunction in the short term. This case report describes an encounter that supports a causal link between anabolic-androgenic steroid use (AAS) and cardiomyopathy later in life. We herein present a case study of a 73-year-old prior Olympic athlete who had misused AAS for 20 years and subsequently was found to have developed a systolic and diastolic cardiomyopathy, presumably due to long-standing left ventricular hypertrophy. A 73-year-old man presented to our medical center with symptoms of lightheadedness and palpitations. He was found to be in ventricular tachycardia and was converted to sinus rhythm with medical pharmacotherapy. Further workup with two-dimensional trans-thoracic echocardiogram and cardiac catheterization showed severe left ventricular (LV) hypertrophy in the absence of hypertension and a combined systolic and diastolic heart failure with reduced ejection fraction in the absence of significant coronary artery disease or dilated cardiac chambers. The patient denies any family or personal history of cardiac issues until the time of presentation. By exclusion, he was diagnosed with a non-ischemic cardiomyopathy secondary to his prior regimented use of anabolic steroids. Although causality can only be inferred, this case presents a potentially delayed long-term cardiac consequences of extreme AAS use over many years. Notably, our patient had remained asymptomatic, until the development of arrhythmias, eventuating in ventricular tachycardia and contributing to heart failure with reduced ejection fraction. Physicians should caution users about the risk of possible long-term cardiac complications linked with AAS use.

Anabolic Steroids and Cardiovascular Outcomes: The Controversy

“…This raises the question of how many younger athletes are at risk. Ha et al reported a case involving an AS user who developed left ventricular hypertrophy after 20 years of AS use [19]. Pirompol et al discovered cardiomegaly in rats over an [8][9][10][11][12] week period of using AS [20].…”

Decompensated Non-Ischemic Cardiomyopathy Induced by Anabolic-Androgenic Steroid Abuse

“…Exogenous AAS use is rapidly becoming an emergent public health concern, as some estimates indicate that 3-4 million Americans use some form of AAS [ 6 ]. AASs have been studied to show interactions within the bone, brain, endocrine, muscle, prostate, hematopoietic, and even CVD system [ 7 ]. Anabolic steroids have been linked to various cardiac adverse effects.…”

Irreversible Dilated Cardiomyopathy After Abuse of Anabolic Androgenic Steroids: A Case Report and Literature Review

“…Our case highlights an interesting presentation of a dilated cardiomyopathy with acute decompensated heart failure one year after cessation of anabolic steroids in a patient who had performed intensive physical training, and showed no improvement of the ejection fraction after cessation of the abuse and initiation of conventional heart failure therapy. In literature there are several reports documenting AAS-induced cardiotoxicity and in particular DCM [1][2][3][4][5][6][7][8][9][10][11][12][13] (Table 1) although few of them indicate irreversible effects on cardiac muscle performance [1,6,8,13] Table . We believe that what can happen in irreversible myocytes damage like in ours patient or even in fatal cases [14,15], is a more profound damage to the myocytes that can be caused by the synergism of AAS, possibly at high dosage and for a prolonged span of time with other factors that enhance the AAS damage, first of all strenuous exercise training. We will examine first the AAS general toxic effect mechanisms on cardiac myocytes and then the AAS synergism with strenous exercise and with other potential myocites damaging factors like the growth hormone (GH).…”

“…The effect of abuse of these hormones on the body and in particular on the heart is still not entirely known. These substances can produce adverse effects on various organs, and in literature several cases of cardiac disease have been reported in athletes after previous abuse of AASs [1][2][3][4][5][6][7][8][9][10][11][12][13] documenting dilated cardiomyopathy (DCM). However only few of them have shown irreversible DCM [1,6,8,13].…”

“…These substances can produce adverse effects on various organs, and in literature several cases of cardiac disease have been reported in athletes after previous abuse of AASs [1][2][3][4][5][6][7][8][9][10][11][12][13] documenting dilated cardiomyopathy (DCM). However only few of them have shown irreversible DCM [1,6,8,13]. We report the case of a 31-yearold white male, bodybuilder, who had previously used AASs.…”