NEW RESEARCH has demonstrated that supraphysiologic doses of anabolic androgenic steroids (AASs) is associated with persistent coronary microvascular dysfunction, even years after cessation.
This study aimed to investigate coronary microcirculation in men with current or former AAS use compared to controls with no history of AAS use. Conducted between November 2021 and August 2023, the cross-sectional study involved 90 recreational strength-training men with no established cardiovascular disease. Participants underwent cardiac rubidium 82 (⁸²Rb) positron emission tomography/computed tomography (PET/CT) imaging to assess myocardial flow reserve (MFR) at rest and during adenosine-induced stress. Impaired MFR, a marker of coronary microvascular dysfunction, was defined as values less than 2, while subclinical impairment was defined as values less than 2.5. The results showed that impaired MFR was observed in 18.8% of current users, 3.2% of former users, and none of the controls (P=0.02). Subclinical impairment was significantly higher among current (28.1%) and former users (25.8%) compared to controls (3.7%) (P=0.02). Additionally, in men with former AAS use, each doubling of accumulated AAS exposure was associated with a twofold increased risk of MFR less than 2.5 (odds ratio 2.1, 95% CI 1.03-4.35, P=0.04).
These findings suggest that coronary microvascular dysfunction persists long after discontinuation of AAS use, likely reflecting irreversible cardiovascular effects from prolonged supraphysiologic AAS exposure. In clinical practice, this highlights the importance of assessing cardiac function in individuals with a history of AAS use, even years after cessation. Future research should focus on identifying mechanisms underlying this dysfunction and exploring targeted interventions to mitigate long-term cardiovascular risks. This work underscores the need for increased awareness among healthcare providers and patients regarding the cardiovascular risks associated with AAS use.
Katrina Thornber, EMJ
Reference
Bulut Y et al. Coronary microvascular dysfunction years after cessation of anabolic androgenic steroid use. JAMA Netw Open. 2024;7(12):e2451013.
