title: Anabolic steroids and cardiovascular risk: A national population-based cohort study.
abstract: BACKGROUND
  Non-therapeutic use of anabolic androgenic steroids (AAS) has been associated with various adverse effects; one of the most serious being direct cardiovascular effects with unknown long-term consequences. Therefore, large studies of the association between AAS and cardiovascular outcomes are warranted. We investigated cardiovascular morbidity and mortality in individuals who tested positive for AAS.
  
  
  RESULTS
  Between 2002 and 2009, a total of 2013 men were enrolled in a cohort on the date of their first AAS test. Mortality and morbidity after cohort entry was retrieved from national registries. Of the 2013 individuals, 409 (20%) tested positive for AAS. These men had twice the cardiovascular morbidity and mortality rate as those with negative tests (adjusted hazard ratio (aHR) 2.0; 95% confidence interval (CI) 1.2-3.3). Compared to the Swedish population, all tested men had an increased risk of premature death from all causes (standardized mortality ratio for AAS-positive: 19.3, 95% CI 12.4-30.0; for AAS-negative: 8.3, 95% CI 6.1-11.0).
  
  
  CONCLUSIONS
  Non-therapeutic exposure to AAS appears to be an independent risk factor for cardiovascular morbidity and premature death.
authors.affiliation: Dept. of Surgical Sciences, Uppsala University, Uppsala, Sweden. Electronic address: Ingemar.thiblin@surgsci.uu.se.
authors.forename: Ingemar
authors.initials: I
authors.lastname: Thiblin
authors.affiliation: King's College London, Medical School, London, UK.
authors.forename: Hans
authors.initials: H
authors.lastname: Garmo
authors.affiliation: Division of Clinical Pharmacology, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Mats
authors.initials: M
authors.lastname: Garle
authors.affiliation: Dept. of Surgical Sciences, Uppsala University, Uppsala, Sweden; King's College London, Medical School, London, UK.
authors.forename: Lars
authors.initials: L
authors.lastname: Holmberg
authors.affiliation: Dept. of Surgical Sciences, Uppsala University, Uppsala, Sweden.
authors.forename: Liisa
authors.initials: L
authors.lastname: Byberg
authors.affiliation: Dept. of Surgical Sciences, Uppsala University, Uppsala, Sweden.
authors.forename: Karl
authors.initials: K
authors.lastname: Michaëlsson
authors.affiliation: Dept. of Surgical Sciences, Uppsala University, Uppsala, Sweden; Medical Products Agency, Uppsala, Sweden.
authors.forename: Rolf
authors.initials: R
authors.lastname: Gedeborg
mesh_terms: D000293:Adolescent; D000328:Adult; D045930:Anabolic Agents / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000139:chemically induced* / Q000453:epidemiology* / Q000401:mortality; D002423:Cause of Death; D015331:Cohort Studies; D004522:Educational Status; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D061213:Mortality, Premature; D012042:Registries; D012959:Socioeconomic Factors; D013256:Steroids / Q000009:adverse effects*; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult
chemical_list: D045930:Anabolic Agents; D013256:Steroids
keywords: Anabolic androgenic steroids; Cardiac disease; Injury; Morbidity; Mortality; Psychiatric disease