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How Substance Use Patterns Shape Perceived Cardiac Concern Among An International Sample of Men Who Use

Bahareh Ahmadinejad¹, Benjamin Bonenti¹, Kimberley Akrigg¹

¹School of Public Health, Faculty of Health, Medicine and Behavioural Sciences, The University of Queensland, Brisbane, Australia.

Substance Use & Addiction Journal

|July 7, 2026

Abstract

Background:

Cardiovascular side effects are commonly reported by men who use anabolic-androgenic steroids (AAS), yet little is known about the factors that increase risk. This study examines data from the 2024 Global Drug Survey (GDS2024) to identify whether route of administration (ROA), image-and performance enhancing drug (IPED) polypharmacy and licit substance use are associated with self-reported cardiovascular-related concerns.

Methods:

The dataset comprised 1167 males (≥16 years) who had used AAS within the previous 12 months. Descriptive statistics summarized demographic and substance use characteristics. Chi-square tests explored associations between self-reported cardiovascular side effects and ROA (oral vs injectable), IPED polypharmacy, and licit substance use respectively. Independent predictors were identified through multivariable binary logistic regression. Associations between substances were investigated using pairwise models. Visualizations included heatmaps, bar charts, forest plots, trend stability, and performance comparisons across models.

Results:

Showed that, among AAS consumers, 35.7% reported a self-reported cardiovascular-related concern. Alcohol (79.4%), tobacco (42.0%), and E-cigarette use (40.5%) were prevalent among AAS consumers. Clenbuterol use differed significantly by ROA, reported by 28.4% of oral and 24.3% of injectable AAS consumers. Injectable AAS use was strongly associated with concurrent human hormone growth (HGH) and insulin use. In adjusted models, injectable AAS use showed the strongest association with self-reported cardiovascular-related concerns (OR = 10.57, P < .001), followed by oral AAS use (OR = 1.92, P < .001) and clenbuterol use (OR = 1.44, P = .044). Age, HGH, insulin, alcohol, tobacco, and e-cigarette use were not significantly associated with cardiovascular-related concerns. Pairwise analyses indicated that clenbuterol-containing substance combinations were associated with higher odds of reporting cardiovascular-related concerns, highlighting the relevance of ROA and patterns of concurrent substance use.

Conclusions:

Negative cardiovascular health concerns among AAS consumers are most strongly associated with oral routes and use of substances like clenbuterol.

Keywords:

alcohol anabolic-androgenic steroid cardiovascular concern clenbuterol co-substance use polypharmacy tobacco

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