Long-term anabolic-androgenic steroid use is associated with left ventricular dysfunction.
BACKGROUND
Although illicit anabolic-androgenic steroid (AAS) use is widespread, the cardiac effects of long-term AAS use remain inadequately characterized. We compared cardiac parameters in weightlifters reporting long-term AAS use to those in otherwise similar weightlifters without prior AAS exposure.


RESULTS
We performed 2D tissue-Doppler and speckle-tracking echocardiography to assess left ventricular (LV) ejection fraction, LV systolic strain, and conventional indices of diastolic function in long-term AAS users (n=12) and otherwise similar AAS nonusers (n=7). AAS users (median [quartile 1, quartile 3] cumulative lifetime AAS exposure, 468 [169, 520] weeks) closely resembled nonusers in age, prior duration of weightlifting, and current intensity of weight training. LV structural parameters were similar between the two groups; however, AAS users had significantly lower LV ejection fraction (50.6% [48.4, 53.6] versus 59.1% [58.0%, 61.7%]; P=0.003 by two-tailed Wilcoxon rank sum test), longitudinal strain (16.9% [14.0%, 19.0%] versus 21.0% [20.2%, 22.9%]; P=0.004), and radial strain (38.3% [28.5%, 43.7%] versus 50.1% [44.3%, 61.8%]; P=0.02). Ten of the 12 AAS users showed LV ejection fractions below the accepted limit of normal (>or=55%). AAS users also demonstrated decreased diastolic function compared to nonusers as evidenced by a markedly lower early peak tissue velocity (7.4 [6.8, 7.9] cm/s versus 9.9 [8.3, 10.5] cm/s; P=0.005) and early-to-late diastolic filling ratio (0.93 [0.88, 1.39] versus 1.80 [1.48, 2.00]; P=0.003).


CONCLUSIONS
Cardiac dysfunction in long-term AAS users appears to be more severe than previously reported and may be sufficient to increase the risk of heart failure.
Baggish
Aaron L
AL
Division of Cardiology, Massachusetts General Hospital, and Department of Medicine, Harvard Medical School, Boston, Mass 02114, USA. abaggish@partners.org
Weiner
Rory B
RB
Kanayama
Gen
G
Hudson
James I
JI
Picard
Michael H
MH
Hutter
Adolph M
AM
Pope
Harrison G
HG
D000328:Adult; D045930:Anabolic Agents / Q000009:adverse effects*; D000728:Androgens / Q000009:adverse effects*; D016022:Case-Control Studies; D003971:Diastole / Q000187:drug effects; D018450:Disease Progression; D004300:Doping in Sports; D004305:Dose-Response Relationship, Drug; D015150:Echocardiography, Doppler; D017079:Exercise Tolerance / Q000187:drug effects; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D016014:Linear Models; D008297:Male; D009200:Myocardial Contraction / Q000187:drug effects; D011336:Probability; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D013599:Systole / Q000187:drug effects; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000139:chemically induced* / Q000000981:diagnostic imaging
D045930:Anabolic Agents; D000728:Androgens