Cardiovascular Disease in Anabolic Androgenic Steroid Users
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Published on: September 27, 2024
Josefine Windfeld-Mathiasen1,2, Ida M Heerfordt1, Kim Peder Dalhoff1,2
1Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark (J.W.-M., I.M.H., K.P.D., J.T.A., M.A.A., K.S.J., H.H.).
Insights
Anabolic androgenic steroid (AAS) use significantly elevates the risk of cardiovascular events, including heart attack and heart failure. This large-scale study confirms a substantially increased risk for AAS users compared to the general population.
Area of Science:
- Cardiology
- Endocrinology
- Public Health
Background:
- Anabolic androgenic steroid (AAS) use is linked to increased mortality, with cardiovascular disease implicated in some deaths.
- The cardiovascular health impact on AAS users remains understudied.
- This research investigates cardiovascular disease incidence in male AAS users versus the general population.
Purpose of the Study:
- To quantify the incidence of cardiovascular disease in male AAS users.
- To compare cardiovascular disease rates in AAS users against a matched general population cohort.
- To identify specific cardiovascular risks associated with AAS use.
Main Methods:
- A cohort of male AAS users sanctioned in Denmark (2006-2018) was established.
- A 50:1 age- and sex-matched control group from the general Danish population was selected.
- Nationwide registries tracked cardiovascular events (e.g., myocardial infarction, cardiomyopathy) and other health data until June 2023.
Main Results:
- AAS users (n=1189) showed significantly higher cardiovascular event rates than controls (n=59,450) over an 11-year follow-up.
- AAS use was associated with increased risks for acute myocardial infarction (aHR 3.00), revascularization procedures (aHR 2.95), venous thromboembolism (aHR 2.42), arrhythmias (aHR 2.26), cardiomyopathy (aHR 8.90), and heart failure (aHR 3.63).
- Limited data precluded reporting on ischemic stroke and cardiac arrest incidence in AAS users.
Conclusions:
- Anabolic androgenic steroid use is linked to a substantially increased risk of cardiovascular disease.
- The findings highlight significant cardiovascular dangers associated with AAS consumption.
- This study underscores the need for awareness and preventative strategies regarding AAS-related cardiovascular risks.
Background:
Use of anabolic androgenic steroids (AASs) is associated with increased mortality, and case reports have suggested that some of these deaths are due to cardiovascular disease. However, the epidemiology of cardiovascular disease in AAS users is still relatively unexplored. This study aimed to measure the incidence of cardiovascular disease in male AAS users and to compare these rates with those of a cohort from the general population matched by age and sex.
Methods:
Men sanctioned in an antidoping program for AAS use in Danish fitness centers between 2006 and 2018 were included and matched for age and sex with 50 times as many controls from the general Danish population. The cohort was followed until June 30, 2023. Using the nationwide registries, we obtained information on admissions, prescriptions, educational length, and occupational status for both the AAS users and controls. This study investigated the incidence of acute myocardial infarction, percutaneous coronary intervention, or coronary artery bypass graft, venous thromboembolism, ischemic stroke, arrhythmia, cardiomyopathy, heart failure, and cardiac arrest during the follow-up period.
Results:
During an average of 11 years of follow-up, AAS users (n=1189) demonstrated a significantly higher incidence of several cardiovascular events compared with controls (n=59 450). Correspondingly, AASs were associated with an increased risk of acute myocardial infarction (adjusted hazard ratio [aHR] 3.00 [95% CI, 1.67-5.39]), percutaneous coronary intervention or coronary artery bypass graft (aHR 2.95 [95% CI, 1.68-5.18]), venous thromboembolism (aHR 2.42 [95% CI, 1.54-3.80]), arrhythmias (aHR 2.26 [95% CI, 1.53-3.32]), cardiomyopathy (aHR 8.90 [95% CI, 4.99-15.88]), and heart failure (aHR 3.63 [95% CI, 2.01-6.55]). Due to the limited number of ischemic stroke and cardiac arrest cases among AAS users, these outcomes were not reportable.
Conclusions:
AAS use is associated with a substantially increased risk of cardiovascular disease in a large cohort with a long follow-up period.
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