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Longterm anabolic steroid use linked to severe cardiac dysfunction

Circulation: Heart Failure 2010; Advance online publication

Long-term anabolic steroid use seems to result in more severe cardiac dysfunction than previously recognized, and may be sufficient to increase the risk for heart failure, report researchers.

In a small study, they found evidence of significantly impaired systolic and diastolic function in long-term users of anabolic-androgenic steroids compared with nonusers.
"What we hope is that people start recognizing steroid use as a potential cause of heart disease and a cause of otherwise unexplained heart dysfunction in young people,"
commented lead author Aaron Baggish (Massachusetts General Hospital, Boston, USA).

Writing in the journal Circulation: Heart Failure, Baggish and colleagues explain that anabolic androgenic steroids include testosterone and its synthetic derivatives. Although numerous case reports of cardiac death among anabolic steroid users suggest a causal link with cardiovascular disease, to date only limited studies of the impact of steroid use on cardiac function have been possible.

Illicit anabolic steroid use became widespread in the USA in the 1980s, and as the first wave of users reaches middle age it is becoming more feasible and "increasingly critical" to study cardiac structure and function in this population, the researchers say.

Here, the team studied a steroid-using group of 12 male weight lifters, average age 40 years, who reported taking median weekly doses of 675 mg testosterone equivalent for 468 lifetime weeks, and a control group of seven age-matched, male weight lifters who reported no steroid use.

The groups were similar in prior duration of weight lifting, current hours per week training and other intense athletic activity, body-mass index, and body surface area, although as expected the steroid users were significantly more muscular, according to fat-free mass index measurements.

Using 2-dimensional, tissue-Doppler echocardiography the authors found that left ventricular (LV) structural parameters were similar between groups. However, LV ejection fraction was subnormal (≤55%) in 10 (83%) of the anabolic steroid users compared with just one (14%) nonuser.Systolic dysfunction among steroid users was further evidenced by their significantly lower LV peak systolic strain compared with nonusers, with longitudinal strain of 16.9% versus 21.0%, respectively, and radial strain of 38.3% versus 50.1%.

In addition, steroid users demonstrated decreased diastolic function, with a markedly lower early peak tissue velocity (E’; 7.4 vs 9.9 cm/sec) and ratio of early to late diastolic filling (E/A ratio; 0.93 vs 1.80) compared with nonusers.

"Further work is needed to confirm our findings and to determine the extent to which anabolic-androgenic-steroid-associated cardiac dysfunction leads to adverse outcomes," the authors conclude.

Read the abstract

MedWire ( is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2010