What are the specific mechanisms by which anabolic steroids cause Left Ventricular Hypertrophy (LVH)?

From the Guidelines

Anabolic steroids cause left ventricular hypertrophy (LVH) through direct stimulation of protein synthesis and myocardial cell growth, as well as indirect effects on blood pressure and cardiac afterload. The specific mechanisms by which anabolic steroids cause LVH involve binding to androgen receptors in cardiac muscle cells, leading to increased cardiac muscle mass and wall thickness 1. Additionally, anabolic steroids elevate blood pressure by enhancing sodium and water retention, increasing blood volume, and causing vasoconstriction through effects on the renin-angiotensin-aldosterone system.

Some key points to consider about the effects of anabolic steroids on the heart include:

• Direct stimulation of protein synthesis and myocardial cell growth
• Increased cardiac muscle mass and wall thickness
• Elevated blood pressure due to sodium and water retention, increased blood volume, and vasoconstriction
• Increased afterload from hypertension, forcing the heart to work harder and contributing to compensatory hypertrophy
• Alteration of the balance of anabolic and catabolic processes in cardiac tissue, favoring protein accumulation
• Promotion of collagen deposition in the myocardium, leading to fibrosis and structural remodeling

It is essential to note that the specific effects of anabolic steroids on the heart can vary by steroid type, dosage, and duration of use, with some compounds being more strongly associated with cardiac hypertrophy than others, as mentioned in the context of drugs that can cause LVH, including anabolic steroids, tacrolimus, and hydroxychloroquine 1.

From the Research

Mechanisms of Left Ventricular Hypertrophy (LVH) caused by Anabolic Steroids

• Anabolic steroids can induce left ventricular hypertrophy and impaired systolic and diastolic function in amateur strength athletes, with the structural cardiac changes being positively associated with anabolic steroid dose 2.
• The use of anabolic steroids may potentiate the development of cardiac dysfunction in the short term, and long-term use can lead to non-ischemic cardiomyopathy secondary to left ventricular hypertrophy 3.
• Anabolic steroids can cause cardiac hypertrophy, with increases in left ventricular posterior wall and ventricular septal thickness, and a significantly smaller left ventricular end-diastolic dimension when indexed to body mass 4.

Pathophysiological Changes

• Anabolic steroids can induce maladaptive remodeling and further deterioration in cardiac performance, with exercise training associated with anabolic steroids causing loss of the beneficial effects in left ventricular function induced by exercising 5.
• The local renin-angiotensin system is activated by anabolic steroids, leading to increased collagen synthesis and cardiac hypertrophy, which can be prevented by losartan treatment 5.
• Anabolic steroids can also cause a decline in left ventricular ejection fraction, a decline in E/A-ratio, and an increase in left atrial volume, with these changes being reversible after discontinuation of anabolic steroid use 2.

Clinical Implications

• Physicians should caution users about the risk of possible long-term cardiac complications linked with anabolic steroid use, including left ventricular hypertrophy, cardiac dysfunction, and non-ischemic cardiomyopathy 3, 6.
• The use of anabolic steroids can have serious cardiovascular side effects, including ventricular fibrillation, heart failure, and arterial thrombus, highlighting the need for careful monitoring and management of athletes using these substances 6.