Steroids and Heart Disease

[DRveejay11]

http://www.ncbi.nlm.nih.gov/pubmed/18388062?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed _ResultsPanel.Pubmed_RVDocSum&ordinalpos=2

Acute myocardial infarction in a young man using anabolic steroids.
Wysoczanski M, Rachko M, Bergmann SR.

Department of Internal Medicine Beth Israel Medical Center, New York, NY 10003, USA. mwysoczanski@gmail.com

Anabolic-androgenic steroids are used worldwide to help athletes gain muscle mass and strength. Their use and abuse is associated with numerous side effects, including acute myocardial infarction (MI). We report a case of MI in a young 31-year-old bodybuilder. Because of the serious cardiovascular complications of anabolic steroids, physicians should be aware of their abuse and consequences.

PMID: 18388062 [PubMed - indexed for MEDLINE]

[DRveejay11]

http://www.ncbi.nlm.nih.gov/pubmed/14743229?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed _ResultsPanel.Pubmed_RVDocSum&ordinalpos=4

Tidsskr Nor Laegeforen. 2004 Jan 22;124(2):170-2.

[Acute myocardial infarction in a young man who had been using androgenic anabolic steroids]
[Article in Norwegian]

Halvorsen S, Thorsby PM, Haug E.

Hjerte-Lungesenteret, Ullevål universitetssykehus, 0407 Oslo. sigrun.halvorsen@ulleval.no

BACKGROUND: A few case reports suggest that the use of androgenic anabolic steroids may be associated with myocardial infarction. MATERIAL AND METHODS: Case report. RESULTS: We report the case of a 27-year-old male body builder with acute myocardial infarction due to occlusion of the proximal left anterior descending coronary artery. He was treated with primary angioplasty with stent implantation and intra-aortic balloon support, but still developed a large myocardial infarction as determined by both echocardiography and myocardial perfusion tomography. The patient had been using androgenic anabolic steroids regularly for ten years. There was no family history of heart disease or lipid disorder. INTERPRETATION: The actual frequency of myocardial infarction and even sudden death among users of anabolic steroids is presumably underreported in the medical literature. A causal relationship is not established, but a pathogenic role is plausible. Use of androgenic anabolic steroids has been associated with platelet hyperactivity, effects on vasoreactivity and changes in lipid levels. It is important for clinicians to be aware of this association and to counsel patients carefully about this and other side effects that may occur with these agents.

PMID: 14743229 [PubMed - indexed for MEDLINE]

[DRveejay11]

http://www.ncbi.nlm.nih.gov/pubmed/20020375?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed _ResultsPanel.Pubmed_RVDocSum&ordinalpos=1

Chief Physician/Senior Cardiologist, Oslo University Hospital – Aker, Trondheimsveien 235, 0514-Oslo University Hospital, Oslo, Norway

Abstract
Abuse of anabolic androgenic steroids (AAS) has been linked to a variety of different cardiovascular side effects. In case reports, acute myocardial infarction is the most common event presented, but other adverse cardiovascular effects such as left ventricular hypertrophy, reduced left ventricular function, arterial thrombosis, pulmonary embolism and several cases of sudden cardiac death have also been reported. However, to date there are no prospective, randomized, interventional studies on the long-term cardiovascular effects of abuse of AAS. In this review we have studied the relevant literature regarding several risk factors for cardiovascular disease where the effects of AAS have been scrutinized:
(1) Echocardiographic studies show that supraphysiologic doses of AAS lead to both morphologic and functional changes of the heart. These include a tendency to produce myocardial hypertrophy (Fig. 3), a possible increase of heart chamber diameters, unequivocal alterations of diastolic function and ventricular relaxation, and most likely a subclinically compromised left ventricular contractile function. (2) AAS induce a mild, but transient increase of blood pressure. However, the clinical significance of this effect remains modest. (3) Furthermore, AAS confer an enhanced pro-thrombotic state, most prominently through an activation of platelet aggregability. The concomitant effects on the humoral coagulation cascade are more complex and include activation of both pro-coagulatory and fibrinolytic pathways. (4) Users of AAS often demonstrate unfavorable measurements of vascular reactivity involving endothelial-dependent or endothelial-independent vasodilatation. A degree of reversibility seems to be consistent, though. (5) There is a comprehensive body of evidence documenting that AAS induce various alterations of lipid metabolism. The most prominent changes are concomitant elevations of LDL and decreases of HDL, effects that increase the risk of coronary artery disease. And finally, (6) the use of AAS appears to confer an increased risk of life-threatening arrhythmia leading to sudden death, although the underlying mechanisms are still far from being elucidated. Taken together, various lines of evidence involving a variety of pathophysiologic mechanisms suggest an increased risk for cardiovascular disease in users of anabolic androgenic steroids.

[DRveejay11]

I know I know....there is a body of convincing evidence per se that conversely supports the use of Testosterone for rectifying certain cardiovascular health issues.

I just like to people to know both sides of the coin as opposed to looking through amber-colored-ampules all the time ;)

[Cryptix]

yeah bro, i like that you share an often unpopular view in the gear community. seems like every dude out there wants to imagine they can abuse huge amounts of shit without having any damage done to themselves.

[liftsiron]

A person using steroids should watch blood lipid levels, blood pressure, and after a year or two of use imo an echo cardiogram is a good idea.

[DRveejay11]

yeah bro, i like that you share an often unpopular view in the gear community. seems like every dude out there wants to imagine they can abuse huge amounts of shit without having any damage done to themselves.

Thanks ;)

A person using steroids should watch blood lipid levels, blood pressure, and after a year or two of use imo an echo cardiogram is a good idea.

Could not agree more.

[jboldman]

normally the arterial occulsion would be the result of lipid disorder alone or in combination with an out of range hct. steroids primary effect on the heart is LVH (left ventricular hypertrophy). one of my rules that i advocate as often as this comes up is the use of an ace inhibitor or angiotensin receptor blocker whenever anyone uses steroids. not only will it help with high blood pressure but it will prevent and reverse angiotensin induced LVH. this is a really simple step to take and is imo an absolute must.

jb

[Thate]

jboldman please toss out the names of ace inhibitors you use and the dose you take them.

[DRveejay11]

Very nice JB. Important to say the least!

ACEi and ARB's also help to prevent secondary kidney damage/disease as well in those with hypertension. In addition to that, there is growing evidence that these may also fascilitate a fat loss environment. Nice "side benefits".

http://www.ncbi.nlm.nih.gov/pubmed/19465040?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed _ResultsPanel.Pubmed_RVDocSum&ordinalpos=2

http://www.ncbi.nlm.nih.gov/pubmed/18580864?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed _ResultsPanel.Pubmed_RVDocSum&ordinalpos=18

normally the arterial occulsion would be the result of lipid disorder alone or in combination with an out of range hct. steroids primary effect on the heart is LVH (left ventricular hypertrophy). one of my rules that i advocate as often as this comes up is the use of an ace inhibitor or angiotensin receptor blocker whenever anyone uses steroids. not only will it help with high blood pressure but it will prevent and reverse angiotensin induced LVH. this is a really simple step to take and is imo an absolute must.

jb

[need2lift]

Been on Cozaar (an angiotensin II receptor antagonists) for a few years now and it has really kept my BP in check. I was always borderline high - I can thank my mom's side of the family for that. It's also used to slow long term kidney damage and helps the kidneys eliminate extra fluid.

[liftsiron]

I use atacand a angiotensin receptor blocker, ace inhibitors often give users a pesky dry cough.

[jboldman]

if i were going to take an ARB, i would chose micardis (telmisartan) for the reasons that i pointed out as well as those added by DRveejay and lifts. i use an ace inhibitor since i got my cardiologist to prescribe it. i am one of the lucky ones that does not suffer that dry cough so lisinopril works fine. just a small dose, 5mg.

jb