From the Guidelines
Anabolic steroids can cause numerous serious cardiovascular effects, including altered cholesterol levels, hypertension, cardiac structural changes, increased risk of thrombosis, arrhythmias, and coronary artery disease, as highlighted in a recent scientific statement from the American Heart Association and American College of Cardiology 1. These drugs can significantly alter cholesterol levels, decreasing HDL (good) cholesterol while increasing LDL (bad) cholesterol, creating an atherogenic profile that accelerates atherosclerosis.
- They commonly cause hypertension through increased fluid retention, enhanced sympathetic tone, and direct effects on vascular resistance.
- Cardiac structural changes include left ventricular hypertrophy, which can lead to impaired diastolic function and increased risk of heart failure.
- Steroids also increase the risk of thrombosis by enhancing platelet aggregation and altering coagulation factors, potentially leading to heart attacks and strokes.
- Arrhythmias may occur due to electrolyte imbalances and direct myocardial effects.
- Long-term use can cause coronary artery disease through accelerated atherosclerosis, inflammation, and endothelial dysfunction. The risk of these cardiovascular effects increases with higher doses, longer duration of use, and stacking multiple steroids, as noted in a study on eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities 1. It is essential for individuals using anabolic steroids to be aware of these potential cardiovascular effects and seek immediate medical attention if they experience any symptoms such as chest pain, shortness of breath, palpitations, or severe headaches 1.
From the Research
Adverse Cardiovascular Effects of Anabolic Steroids
The use of anabolic steroids has been associated with a range of adverse cardiovascular effects, including:
- Hypertension and dyslipidaemia, which are risk factors for cardiovascular disease 2
- Coronary atherosclerosis, which can lead to heart attacks and strokes 2, 3, 4
- A pro-coagulative state, which can increase the risk of thromboembolic disease 2
- Left ventricular hypertrophy and dysfunction, which can ultimately result in heart failure 2, 3, 4
- Increased risk of myocardial infarction and sudden cardiac death 5, 4
- Adverse lipid profiles, including reduced HDL cholesterol and increased inflammatory markers 3
- Accelerated atherosclerosis and subclinical cardiomyopathy 4
- Arterial stiffness and ventricular dysfunction 4
Cardiovascular Morbidity and Mortality
Studies have shown that individuals who use anabolic steroids have an increased risk of cardiovascular morbidity and mortality, including:
- Twice the cardiovascular morbidity and mortality rate compared to those who do not use anabolic steroids 5
- An increased risk of premature death from all causes, with a standardized mortality ratio of 19.3 for AAS-positive individuals 5
- A higher risk of cardiovascular disease, including heart attacks, strokes, and cardiac arrhythmias 3, 5, 4
Mechanisms and Risk Factors
The mechanisms underlying the adverse cardiovascular effects of anabolic steroids are not fully understood, but may include: