Cardiac structure and function in anabolic-androgenic steroid users: a 16-year follow-up study

Long-term data on cardiac changes in anabolic-androgenic steroid (AAS) users are lacking. The aim of this study was to explore the effects of AAS on cardiac structure and function during long-term follow-up.

In this prospective cohort study, AAS users and strength-trained non-users were included and examined at two time points with echocardiography and coronary CT angiography. AAS use and non-use were verified by blood and urine analyses.

A cohort of 32 AAS users (median age 33 years) and 13 non-users (median age 34 years) were followed for a median of 16 (IQR, 15-17) and 13 (7-15) years, respectively. At baseline, AAS users had been taking AAS for a median of 5-10 years. At follow-up, 15 had discontinued AAS, while 17 remained continued users. At baseline, AAS users presented with larger left ventricular mass (LVM) (266 g (213-319) vs 215 g (196-217), p<0.01), and lower left ventricular ejection fraction (LVEF) (49% (44-53) vs 53% (51-56), p=0.05), compared with non-users. At follow-up, LVM in discontinued users was reduced and similar to the non-users, while continued users still had larger LVM. LVEF remained significantly impaired in continued users versus non-users (p<0.01). In discontinued users, LVEF seemed to improve over time. The median change in LVEF over time differed significantly between continued and discontinued AAS users (-2 (-6 to 2) vs 3 (1 to 8), p<0.01). Despite higher cardiac troponin T levels in AAS users, coronary artery disease prevalence did not differ between groups.

Long-term AAS use was associated with myocardial remodelling and left ventricular dysfunction. In AAS users who discontinued use during follow-up, left ventricular remodelling and systolic function seemed to improve, even after more than a decade of AAS use.