Contemporary burden and clinical characteristics of hospital admissions for anabolic-androgenic steroid-related cardiovascular complications

Background The use of anabolic–androgenic steroids (AAS) has risen markedly across Europe in recent years, with a further surge observed following the COVID-19 pandemic. Although AAS misuse is often driven by aesthetic and performance goals, accumulating evidence links chronic exposure to a range of cardiovascular complications, including cardiomyopathy, arrhythmias, and thromboembolic events. However, the contemporary burden and clinical characteristics of severe AAS-related cardiovascular disease are not well characterised. Purpose To characterise the contemporary burden and clinical features, management strategies, and outcomes of patients admitted with AAS-related cardiovascular complications. Methods We conducted a retrospective observational study of adults with documented AAS use admitted to a tertiary-care hospital between 1 January 2020 and 1 December 2025. Cardiac complications were prespecified and identified through clinician documentation and discharge coding in the electronic medical record. Owing to the limited sample size, analyses were primarily descriptive. Continuous variables were presented as medians with interquartile ranges, and categorical variables as counts and percentages. Incidence rates of cardiac complications among AAS users were calculated relative to total admissions during the study period. All analyses were performed using IBM SPSS Statistics, version 29.0. Results Twenty-five adults with documented AAS use were identified during the study period, all of whom were male amateur athletes. The median age was 29 years (IQR 25–33). The predominant cardiovascular complications were cardiomyopathy or heart failure (n = 13, 52%) and acute coronary syndromes (n = 7, 28%), followed by clinically significant arrhythmias (n = 3, 12%) and other causes (n = 2, 8%). Among patients with heart failure, the median left ventricular ejection fraction at admission was 32% (IQR 26–38), and median NT-proBNP concentration was 4,250 pg/mL (IQR 2,400–7,600). The incidence of AAS-related cardiac complications was 0.42 per 1,000 hospital admissions, showing a progressive increase from 0.21 per 1,000 in 2020 to 0.65 per 1,000 in 2025 (p < 0.01 for trend). The median length of hospital stay was 6 days (IQR 4–9), and in-hospital mortality was 4% (n = 1). Conclusion Cardiac complications among AAS users primarily affect young male amateur athletes, most often presenting with cardiomyopathy or acute coronary syndromes. The rising incidence of such cases underscores the importance of early recognition and targeted prevention strategies.