ILLEGAL DRUG-taking in sport leads not only to unfair competition but also to significant health risks for those athletes who indulge in it. Of these biomedical side effects, the cardiovascular ones are often the most damaging; several drugs can cause cardiac collateral effects, through a direct or indirect cardiac action, and can provoke arrhythmogenic effects over the short, medium or long term.
Drug-taking: a dangerous sport
The World Anti-Doping Agency (WADA) yearly updates a list of prohibited substances and methods banned by the International Olympic Committee. The list includes different classes of substances: anabolic androgenic steroids, hormones and related substances (e.g. erythropoietin, growth hormone, insulin-like growth factor, mechano growth factors, gonadotropins, insulin and corticotropins), beta-2 agonists, diuretics and other masking agents, stimulants, narcotics, cannabinoids, glucocorticosteroids, alcohol, beta-blockers and others.
Recently the ESC Study Group of Sports Cardiology produced a position paper on “Cardiovascular adverse effects of doping in athletes” which summarises the effects that substances banned by the World Anti-Doping Agency can have (Eur J Cardiovasc Prev Rehabil, in press).
The cardiovascular effects comprehend a wide spectrum of diseases: hypertrophic, dilated, ischaemic cardiomyopathies, myocarditis, thrombo-embolic diseases and also a wide range of supraventricular and/or ventricular cardiac arrhythmias, focal or re-entry type, that are often symptomatic and potentially lethal even in healthy subjects. In addition, sport people often combine several drugs, which leads to an even higher risk of cardiovascular side effects.
People who take illicit drugs and who have pre-existing cardiac diseases (e.g. latent arrhythmogenic substrate or primary arrhythmic disorders, including some inherited cardiomyopathies) have a very high risk of lethal arrhythmias and sudden death (SD).
While a large number of professional and non-professional athletes are known to take illicit drugs, the precise arrhythmogenic effect of any specific substances is not known. Therefore, it is crucial that doping control strategies include the mechanisms of cardiac action and toxic effects of every drug on the current WADA list.
If further progress is to be made in the prevention of “doping”, then, in addition to new anti-doping measures, effective information campaigns need to be carried out among athletes, highlighting the various and dangerous side effects of illicit drugs (including the cardiovascular ones), especially among the youngest and those performing non-competitive sports without any control.
This symposium outlines the main arrhythmologic, pathophysiological and epidemiologic aspects of cardiovascular adverse effects of doping in sport and highlights the challenges to cardiologists and the need to take serious preventive action against drug abuse.