Anabolic Androgenic Steroids

ABCIC

Editorial

A New Frontier in Cardiovascular Prevention: Beyond Prohibition, Clinical Management of Anabolic Steroid Users

Fabio Roston et al. Alexandre Aby Azar Ribeiro Naiara Caroline Makiniks Luiz Felipe Branco Ribeiro Liliana Ludwing Ziegler

Subclinical Diagnosis: The Role of Advanced Echocardiography

Conventional cardiac assessment often fails to detect early damage, as Left Ventricular Ejection Fraction (LVEF) may remain within normal limits despite established myocardial injury. The literature highlights that AAS users exhibit alterations in cardiac geometry and function, including pathological hypertrophy, diastolic dysfunction, and biventricular impairment.^,

In this setting, echocardiography incorporating advanced measurements such as myocardial strain has emerged as an essential diagnostic tool. Although LVEF may remain preserved during the early stages, myocardial deformation (strain) analysis enables the detection of incipient systolic dysfunction resulting from fibrosis and myofibrillar destruction caused by the direct toxic effects of androgens. Recent studies have demonstrated that both current and former AAS users may exhibit persistent biventricular cardiomyopathy, reinforcing the need for continuous monitoring.

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ABCIC

Original Article

Anabolic-Androgenic Steroids and Acute Myocardial Infarction in Young Adults: A Literature Review Based on a Case Series

Fabiana Rocha Botelho de Oliveira et al. Danielli Oliveira de Costa Lino Germano Freire Bezerra Filho Bruno Cavalcante Linhares … Leonardo Brito De Souza Luiz Filipe Torres de Alencar Matheus Rolim Santa Cruz Mateus Paiva Marques Feitosa

Abstract

Background:

The use of anabolic-androgenic steroids (AAS) has increased substantially, especially among young adults seeking aesthetic enhancement and improved physical performance. Scientific evidence demonstrates a significant association between the abuse of these substances and severe cardiovascular events, including acute myocardial infarction (AMI), often occurring in individuals without traditional cardiovascular risk factors.

Objective:

To describe the adverse effects of AAS on the cardiovascular system and the main pathophysiological mechanisms involved in the development of AMI through the analysis of a clinical case series combined with a review of medical literature.

Methods:

A systematic literature review was conducted using the PubMed and SciELO databases, complemented by the analysis of three clinical cases. Demographic variables and characteristics related to AAS use, including duration of exposure and route of administration, were evaluated, with emphasis on the pathophysiological mechanisms associated with AMI.

Results:

Analysis of the clinical cases identified different mechanisms related to AMI, including coronary thrombosis, atherosclerosis with plaque rupture, and spontaneous coronary artery dissection. The literature review also identified other relevant mechanisms, such as coronary vasospasm and toxic myocarditis. A predominance of male patients was observed, with the highest incidence occurring among individuals aged 20-40 years, and testosterone esters were the most frequently used AAS.

Conclusions:

AAS abuse represents a major threat to cardiovascular health and is associated with AMI through multiple pathophysiological mechanisms. These findings reinforce the need for public awareness as well as the development of preventive strategies and clinical guidelines aimed at managing this emerging condition.

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IJCS

Editorial

Anabolic-Androgenic Steroids and Cardiotoxicity

José Antônio Caldas Teixeira et al. Joelma Dominato Rocha Carvalho Mateus Freitas Teixeira

Anabolic-androgenic steroids (AAS) are a class of natural and synthetic hormones, which owe their name to their chemical structure (steroid nucleus) and their biological, anabolic, and androgenic effects. Misuse of AAS for aesthetic and performance purposes has become widespread, as they provide increases in muscle mass and strength. It is estimated that approximately 3.5% of the world’s population uses AAS.

Use of AAS dates back to ancient Greece, followed by the Second World War. They were detected in sports competitions in 1954 and later disseminated among bodybuilders and identified in various sports in the Tokyo 1964 Olympic Games. Currently, we are witnessing a growing encouragement of AAS use for aesthetic purposes, through “beauty chips” and disguised as hormone replacement therapy. This indiscriminate use culminated in a resolution by the Brazilian Federal Council of Medicine against the prescription of these hormones for aesthetic purposes.

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IJCS

Original Article

Systolic Subclinical Dysfunction in Anabolic Steroid Users: A Real Life Study

Renata Rodrigues Teixeira De Castro et al. Marcello de Brito Campos Luiz Mello João Giffoni Silveira Neto

Abstract

Background:

Considering the uncertainty regarding the cardiovascular safety of anabolic steroid use, we believe that the use of advanced echocardiography techniques, such as speckle tracking, may contribute more objectively to the analysis of cardiotoxicity induced by these substances.

Objectives:

To compare, through speckle tracking, the echocardiograms of bodybuilders who abuse anabolic steroids with those who do not use these substances.

Methodology:

This work is a retrospective, observational study that analyzed echocardiograms performed on bodybuilders followed up in an outpatient sports cardiology service, comparing the results between individuals who use and those who have never used anabolic steroids. Continuous data was compared, using unpaired, two-tailed, Student’s T test, with a p-value < 0.05 considered to be significant.

Results:

The final sample of this study included 22 bodybuilders, 14 of whom were anabolic steroid users (UAS) and 8 non-users of anabolic steroids (NUAS). All 22 participants had a left ventricular ejection fraction (LVEF) > 50% (UAS = 55±4 vs. NUAS = 63±1%; p < 0.001). All 14 steroid users showed abnormal global longitudinal strain (GLS), while all 8 non-users presented normal values for this variable (UAS = 13±2 vs. NUAS = 20±2; p < 0.01).

Conclusion:

Bodybuilders who use anabolic steroids, despite having normal values for conventional echocardiography parameters, show a reduction in GLS of the left ventricle. The use of speckle-tracking echocardiography represents an important tool in the analysis of myocardial injury in UAS, offering the possibility of early detection of systolic dysfunction in these individuals.

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ABC

Original Article

Coronary Inflammation by Computed Tomography Pericoronary Fat Attenuation and Increased Cytokines in Young Male Anabolic Androgenic Steroid Users

Francis Ribeiro de Souza et al. Carlos E. Rochitte Douglas Carli Silva Barbara Sampaio … Marisa Passarelli Marcelo R. dos Santos Guilherme W. Fonseca Antonio Carlos Battaglia Filho Kelly Correa Renata Margarida do Val Maurício Yonamine Rosa Maria R. Pereira Carlos Eduardo Negrão Roberto Kalil-Filho Maria Janieire de Nazaré Nunes Alves

Abstract

Background

Anabolic androgenic steroid (AAS) abuse has been associated with coronary artery disease (CAD). Pericoronary fat attenuation (pFA) is a marker of coronary inflammation, which is key in the atherosclerotic process.

Objective

To evaluate pFA and inflammatory profile in AAS users.

Methods

Twenty strength-trained AAS users (AASU), 20 AAS nonusers (AASNU), and 10 sedentary controls (SC) were evaluated. Coronary inflammation was evaluated by mean pericoronary fat attenuation (mPFA) in the right coronary artery (RCA), left anterior descending coronary artery (LAD), and left circumflex (LCx). Interleukin (IL)-1 (IL-1), IL-6, IL-10, and TNF-alpha were evaluated by optical density (OD) in a spectrophotometer with a 450 nm filter. P<0.05 indicated statistical significance.

Results

AASU had higher mPFA in the RCA (-65.87 [70.51-60.70] vs. -78.07 [83.66-72.87] vs.-78.46 [85.41-71.99] Hounsfield Units (HU), respectively, p<0.001) and mPFA in the LAD (-71.47 [76.40-66.61] vs. -79.32 [84.37-74.59] vs. -82.52 [88.44-75.81] HU, respectively, p=0.006) compared with AASNU and SC. mPFA in the LCx was not different between AASU, AASNU, and SC (-72.41 [77.17-70.37] vs. -80.13 [86.22-72.23] vs. -78.29 [80.63-72.29] HU, respectively, p=0.163). AASU compared with AASNU and SC, had higher IL-1, (0.975 [0.847-1.250] vs. 0.437 [0.311-0.565] vs. 0.530 [0.402-0.780] OD, respectively, p=0.002), IL-6 (1.195 [0.947-1.405] vs. 0.427 [0.377-0.577] vs. 0.605 [0.332-0.950] OD, p=0.005) and IL-10 (1.145 [0.920-1.292] vs. 0.477 [0.382-0.591] vs. 0.340 [0.316-0.560] OD, p<0.001). TNF-α was not different between the AASU, AASNU, and SC groups (0.520 [0.250-0.610] vs. 0.377 [0.261-0.548] vs. 0.350 [0.182-430]), respectively.

Conclusion

Compared with ASSNU and controls, AASU have higher mPFA and higher systemic inflammatory cytokines profile suggesting that AAS may induce coronary atherosclerosis through coronary and systemic inflammation.

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