Severe biventricular cardiomyopathy in both current and former long-term users of anabolic-androgenic steroids

ABSTRACT Aims Explore the cardiovascular effects of long-term anabolic-androgenic steroid (AAS)-use in both current and former weightlifting AAS-users, and estimate the occurrence of severe reduced myocardial function and the impact of duration and amount of AAS. Methods In this cross-sectional study 101 weightlifting AAS-users with at least one year cumulative AAS-use (mean 11±7 accumulated years of AAS-use) were compared to 71 non-using weightlifting controls (WLC) using clinical data and echocardiography. Results Sixty-nine were current, 30 former (> 1 year since quitted), and 2 AAS-users were not available for this classification. AAS-users had higher left ventricular mass index (LVMI) (106±26 versus 80±15 g/m 2 , P<0.001), worse LV ejection fraction (LVEF) (49±7 versus 59±5%, P<0.001) and right ventricular global longitudinal strain (RVGLS) (−17.3±3.5 versus −22.8±2.0%, P<0.001), and higher systolic blood pressure (SBP) (141±17 vs. 133±11 mmHg, p<0.001) compared with WLC. In current users accumulated duration of AAS-use was 12±7 years, and in former 9±6 years (quitted 6±6 years earlier). Compared to WLC, LVMI and LVEF were pathological in current and former users (p<0.05) with equal distribution of severely reduced myocardial function (LVEF ≤40%) (11% vs. 10%, NS). In current users estimated life time AAS-dose correlated with reduced LVEF and LVGLS, p<0.05, but not with LVMI, p=0.12. Regression analyses of the total population showed that the strongest determinant of reduced LVEF were not coexisting strength training or hypertension, but history of AAS-use (β −0.53, P<0.001). Conclusions Long-term AAS-users showed severely biventricular cardiomyopathy. The reduced systolic function was also found upon discountied use.