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International Journal of Toxins and Toxics Review Article

Muscle vs. Heart: A Comprehensive Review of Anabolic Steroid-Induced Cardiovascular Risks

  1. Muchukota Sushma Department of Pharmacy Practice, Aditya Bangalore Institute of Pharmacy Education & Research (ABIPER)
  2. Navitha G A Department of Pharmacy Practice, Aditya Bangalore Institute of Pharmacy Education & Research (ABIPER)
  3. Subikchya K Department of Pharmacy Practice, Aditya Bangalore Institute of Pharmacy Education & Research (ABIPER)
  4. Salim AL Abdullah Department of Pharmacy Practice, Aditya Bangalore Institute of Pharmacy Education & Research (ABIPER)
  5. Shobha Rani R.H Department of Pharmacy Practice, Aditya Bangalore Institute of Pharmacy Education & Research (ABIPER)

Abstract

Anabolic-androgenic steroids (AAS) are widely used by athletes and bodybuilders to enhance muscle mass and performance. However, their misuse is associated with serious and often underrecognized cardiovascular risks. Despite their popularity, particularly among young adults, the long-term consequences of AAS abuse on cardiovascular health remain insufficiently explored in the literature. This review aims to: 1. Analyze the cardiovascular implications of AAS use. 2. Elucidate the molecular and physiological mechanisms contributing to AAS-induced cardiovascular damage. 3. Identify existing research gaps, including the need for long-term studies, dose-response evaluations, and analysis of demographic and psychological variables. 4. Propose evidence-based preventive and intervention strategies to mitigate cardiovascular risk in AAS users. A comprehensive review of peer-reviewed literature was conducted using major scientific databases, focusing on studies related to AAS-induced cardiovascular effects. Articles were selected based on relevance, recency, and methodological quality, with particular emphasis on mechanistic insights, epidemiological data, and clinical outcomes. Findings reveal that AAS misuse contributes to various forms of cardiovascular pathology, including left ventricular hypertrophy, endothelial dysfunction, accelerated atherosclerosis, arrhythmias, and increased risk of sudden cardiac death. Structural and functional cardiac alterations are often irreversible and exacerbated by prolonged and high-dose steroid use. Significant gaps remain in understanding dose-response relationships, age and gender-related susceptibility, and the psychosocial motivations behind AAS abuse. While AAS may enhance physical performance, their cardiovascular risks are substantial and largely under recognized, especially among young recreational users. Regular medical monitoring, public education, policy regulation, and the development of interdisciplinary treatment models are urgently needed. Long-term cohort studies and targeted awareness campaigns are essential to addressing this emerging public health concern.

Keywords

References (28)

  1. Baggish AL, Weiner RB. Cardiovascular complications of anabolic steroid use: emerging perspectives. Heart. 2010;96(7):556-7.
  2. Nieschlag E, Vorona E. Medical consequences of doping with anabolic androgenic steroids: effects on reproductive functions. Eur J Endocrinol. 2015;173(2):R47-58.
  3. Pope HG Jr, Wood RI, Rogol A, Nyberg F, Bowers L, Bhasin S. Adverse health consequences of performance-enhancing drugs: an Endocrine Society scientific statement. Endocr Rev. 2014;35(3):341-75.
  4. Kanayama G, Hudson JI, Pope HG Jr. Illicit anabolic-androgenic steroid use. Horm Behav. 2010;58(1):111-21.
  5. Thiblin I, Petersson A. Pharmacoepidemiology of anabolic androgenic steroids: a review. Fundam Clin Pharmacol. 2005;19(1):27-44.
  6. Baggish AL, Weiner RB, Kanayama G, Hudson JI, Lu MT, Hoffmann U, et al. Long-term anabolic steroid use is associated with left ventricular dysfunction. Circ Heart Fail. 2017;10(6):e003635.
  7. Hartgens F, Kuipers H. Effects of androgenic-anabolic steroids in athletes. Sports Med. 2004;34(8):513-54.
  8. Grace F, Sculthorpe N, Baker JS, Davies B. Blood pressure and rate pressure product response in males using high-dose anabolic androgenic steroids (AAS). J Sci Med Sport. 2003;6(3):307-12.
  9. Mahmoudi M, Shokri S. The inflammation-related signaling pathways are implicated in anabolic- androgenic cardiomyopathy. J Cell Physiol. 2020;235(12):9310-7.
  10. Achar S, Rostamian A, Narayan SM. Cardiac and metabolic effects of anabolic-androgenic steroid abuse. Am J Cardiol. 2010;106(6):893-901.
  11. Thacilar D, Pimenta J, Oliveira A, et al. Anabolics and cardiomyopathy in a bodybuilder: case report and review. J Card Fail. 2009;15(6):496-500.
  12. Rocha LC, Oliveira RJ. Mechanistic understanding of anabolic steroid-induced cardiac remodeling. Heart Rhythm. 2021;18(2):250-9.
  13. Baggish AL, Weiner RB. Pathological cardiac hypertrophy and arrhythmias in steroid users. Circulation. 2010;121(10):1271-3.
  14. Nahrendorf M, Swirski FK. How anabolic steroids damage the heart. Eur Heart J. 2022;43(9):897-909.
  15. El-Sakka Al. Mechanisms of endothelial dysfunction in steroid abuse. Asian J Androl. 2003;5(3):223-8.
  16. Sullivan ML, Martinez CM, Gallagher EJ. The cardiac toxicity of anabolic steroids. Prog Cardiovasc Dis. 1998;41(1):1-15.
  17. Graham MR, Evans P, Davies B, Baker JS. Cardiovascular and cerebrovascular responses to steroids. Brain Res Bull. 2008;76(4):327-34.
  18. Seara Cardoso A, Brito D, Silva R, et al. Irreversibility of steroid-induced cardiac fibrosis. Cardiol Rev. 2020;28(3):123-9.
  19. Pope HG Jr, Wood RI, Rogol A, Nyberg F, Bowers L, Bhasin S. Prevalence of anabolic steroid use and dependence. Am J Addict. 2014;23(4):371-7.
  20. Piacentino D, Kotzalidis GD, del Casale A, et al. Steroid use and psychopathology in athletes. Curr Neuropharmacol. 2015;13(1):101-21.
  21. Smit DL, Voogel AJ. Cardiovascular risk in steroid users vs metabolic syndrome patients. Int J Cardiol. 2022;345:95-101.
  22. Vorona E, Nieschlag E. Androgens and cardiovascular risk in women and men. Climacteric. 2018;21(4):311-7.
  23. Bagatell CJ, Bremner WJ. Androgens in men-uses and abuses. N Engl J Med. 1996;334(11):707- 14.
  24. Kanayama G, Hudson JI, Pope HG Jr. Features of men with steroid dependence. Drug Alcohol Depend. 2009;102(1-3):130-7.
  25. Griffiths S, Murray SB, Mitchison D, Mond JM. Media exposure and muscularity-focused eating issues in men. Clin Psychol Rev. 2015;39:55-68.
  26. Pope HG Jr, Wood RI, Rogol A, Nyberg F, Bowers L, Bhasin S. Endocrine Society scientific statement on PED use. Endocr Rev. 2014;35(3):341-75.
  27. Brennan BP, Kanayama G, Hudson JI, Pope HG Jr. Human growth hormone abuse in weightlifters. Am J Addict. 2011;20(1):9-13.
  28. Parkinson AB, Evans NA. Survey of 500 steroid users. Med Sci Sports Exerc. 2006;38(4):644-51.