Can hypertrophic cardiomyopathy (HCM) be acquired through steroid use, specifically anabolic steroids?

From the Guidelines

Hypertrophic cardiomyopathy (HCM) cannot be directly acquired through steroid use, but anabolic steroid use can lead to a condition that mimics HCM, characterized by pathological cardiac hypertrophy. According to the 2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy 1, HCM is a disease state characterized by unexplained left ventricular (LV) hypertrophy associated with nondilated ventricular chambers in the absence of another cardiac or systemic disease. While anabolic steroids can cause cardiac hypertrophy, this condition is distinct from genetic HCM.

Key differences between steroid-induced hypertrophy and genetic HCM include:

• The pattern of hypertrophy, with steroid-induced hypertrophy often showing more uniform thickening rather than the asymmetric septal hypertrophy characteristic of genetic HCM
• The potential for partial reversal of hypertrophy if steroid use is discontinued, although complete reversal is not guaranteed, especially after long-term use
• The mechanism of hypertrophy, which involves direct binding of steroids to androgen receptors in cardiac tissue, promoting protein synthesis and myocardial cell growth, as well as increased blood pressure and altered lipid profiles.

It is essential to note that the use of anabolic steroids can lead to serious cardiac risks, and individuals using or considering these substances should be aware of these potential risks. The 2011 ACCF/AHA guideline 1 emphasizes the importance of distinguishing HCM from other cardiac conditions, including hypertensive heart disease and athletic training-related physiologic remodeling, to ensure accurate diagnosis and appropriate management.

From the Research

Hypertrophic Cardiomyopathy and Steroid Use

• Hypertrophic cardiomyopathy (HCM) is a condition characterized by thickening of the heart muscle, which can lead to obstruction of blood flow and increased risk of sudden cardiac death.
• The use of anabolic steroids has been linked to the development of HCM, as evidenced by several studies 2, 3, 4, 5.
• A case study published in 2018 found that long-term use of anabolic-androgenic steroids (AAS) can lead to the development of non-ischemic cardiomyopathy secondary to left ventricular hypertrophy 2.
• Another study published in 2023 compared the left ventricular function of strength-trained athletes using AAS to those with genetic HCM, and found that both groups had similar features, including left ventricular hypertrophy and reduced global strain 3.
• A case report published in 2022 described a young non-athletic female who developed reversible cardiomyopathy after using anabolic steroids, which improved after cessation of steroid use 4.
• An earlier study published in 1984 reported a case of steroid-induced hypertrophic cardiomyopathy in an infant, which resolved after discontinuation of steroid therapy 5.

Key Findings

• The use of anabolic steroids can lead to the development of HCM, particularly with long-term use 2, 3, 4.
• HCM caused by steroid use can be reversible, as evidenced by case reports of improvement after cessation of steroid use 4, 5.
• The diagnosis of HCM in individuals using anabolic steroids can be challenging, and requires careful evaluation of left ventricular function and myocardial structure 3.

Steroid-Induced Cardiomyopathy

• Steroid-induced cardiomyopathy can occur in both athletic and non-athletic populations, and is a growing public health concern 4.
• The condition can present with symptoms such as exertional dyspnea, palpitations, and pulmonary edema, and can be diagnosed using echocardiography and cardiac MRI 2, 4.
• Treatment of steroid-induced cardiomyopathy typically involves cessation of steroid use and guideline-directed therapy for heart failure 4.