Cardiovascular Disease in Anabolic Androgenic Steroid Users.
Level 3 - non-randomized controlled study
Retrospective matched cohort study linked to nationwide registries
PubMed 39945117 · doi:10.1161/CIRCULATIONAHA.124.071117
What was done
Men sanctioned for anabolic androgenic steroid (AAS) use in Danish fitness center antidoping programs between 2006 and 2018 (n=1,189) were matched 1:50 by age and sex to general population controls (n=59,450). Nationwide Danish registries provided data on medical diagnoses, prescriptions, education, and occupational status through June 30, 2023 (mean follow-up: 11 years). The study evaluated adjusted hazard ratios (aHR) for acute myocardial infarction, coronary revascularization (PCI/CABG), venous thromboembolism, ischemic stroke, arrhythmia, cardiomyopathy, heart failure, and cardiac arrest.
What was found
AAS users had significantly higher incidence rates of major cardiovascular conditions compared with matched controls: - Acute myocardial infarction: aHR 3.00 (95% CI, 1.67–5.39) - PCI or CABG: aHR 2.95 (95% CI, 1.68–5.18) - Venous thromboembolism: aHR 2.42 (95% CI, 1.54–3.80) - Arrhythmia: aHR 2.26 (95% CI, 1.53–3.32) - Cardiomyopathy: aHR 8.90 (95% CI, 4.99–15.88) - Heart failure: aHR 3.63 (95% CI, 2.01–6.55) Ischemic stroke and cardiac arrest had too few cases among AAS users to be reported.
Why it matters
This study provides long-term, population-matched epidemiological evidence that illicit AAS use substantially increases the risk of severe cardiovascular disease, showing a nearly ninefold increase in cardiomyopathy and a threefold increase in myocardial infarction.
Limits
The cohort of AAS users was defined solely by antidoping sanctions in fitness centers, which may select for a specific subset of users and miss undetected users in the control group. Registry data lacked details on specific AAS compounds, dosages, cycles, duration of use, concurrent illicit substance use, smoking, and dietary habits, leaving potential for residual confounding. Case counts for cardiac arrest and ischemic stroke were insufficient for analysis.
Cited by
- partial Using anabolic steroids for muscle mass is associated with a 15-fold increased risk of premature heart failure and a 122-fold increased risk of cardiac death.