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

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/m2, 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.