Cardiovascular effects of continued vs. discontinued anabolic-androgenic steroid use: a longitudinal follow-up study

Anabolic-androgenic steroid (AAS) use is prevalent among men engaged in strength training and is associated with adverse structural and functional cardiac changes, but longitudinal data are lacking. This follow-up study examined myocardial effects of AAS with continued use and reversibility following discontinuation.

Participants of a previously published cohort (2017-19) of 101 AAS users and 71 non-using weightlifting controls (WLCs) were invited for a follow-up study and underwent interviews, hormonal profiling, and transthoracic echocardiography. Current AAS users at baseline were continued or discontinued users at follow-up, while former users at baseline were those with continued abstinence and those who relapsed.Among those re-enrolled, 70 were AAS users, of whom 35 continued, 15 discontinued, 14 maintained abstinence, and 6 relapsed, and 35 were WLCs. Continued AAS users had persistent indexed left ventricular mass (LVMI 119 ± 30 g/m2), reduced LV ejection fraction (LVEF 48 ± 10%), and worsened diastolic function. Continued AAS users receiving antihypertensive therapy showed improved LVEF compared with untreated users (Δ = 5 ± 8 vs. -4 ± 8%, P = 0.005). Discontinued AAS users showed reduction in LVMI (Δ = -21 g/m2, P = 0.01) and improved LVEF (Δ = 6%, P < 0.001). At follow-up, these changes were comparable with WLCs, which showed statistically but clinically insignificant differences.

Continued AAS use was associated with sustained LV hypertrophy, LV systolic dysfunction, and worsening diastolic function. Antihypertensive therapy among ongoing AAS users was associated with improved LV systolic function. Discontinuation of AAS use was associated with improvement in cardiac structure and function towards values observed in WLCs.