Key result
Heavy steroid and energy drink use linked to rapid LAD thrombosis in a 26-year-old athlete.
Why the study?
Stimulants and anabolic steroids play a role in plaque disruption resulting in acute coronary syndrome in young adults.
Case Report (n=1)
Synergistic stimulant and anabolic steroid exposure can lead to rapid progression from nonobstructive plaque to acute coronary thrombosis in young adults.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“An important reminder that: MINOCA is not always benign; Nonobstructive plaque can rapidly evolve into catastrophic coronary thrombosis; Toxic exposures may dramatically accelerate endothelial injury and plaque instability in young adults.”
May warrant vigilance for rapid thrombosis in young adults with combined stimulant-steroid use; hypothesis-generating case report requiring confirmation.
BACKGROUND: Stimulants and anabolic steroids have a role in plaque disruption resulting in acute coronary syndrome in young adults. CASE SUMMARY: A 26-year-old bodybuilder with heavy use of anabolic steroids and energy drinks presented with chest pain and ST-segment changes. Coronary angiography revealed minimal nonobstructive plaque in the proximal left anterior descending artery and left ventricular systolic dysfunction. He was started on guideline-directed medical therapy and counseled to discontinue toxic exposures. Weeks later, he presented with recurrent chest pain and was found to have an acute thrombotic occlusion of the mid-left anterior descending artery requiring urgent revascularization and a drug-eluting stent placement. DISCUSSION: This case highlights how synergistic stimulant and anabolic exposure can create dynamic coronary pathology and contribute to endothelial injury, hypercoagulability, and accelerated atherosclerosis. TAKE-HOME MESSAGES: Nonobstructive coronary findings do not exclude imminent coronary thrombosis in high-risk young adults. Risk factor cessation and close follow-up are essential.
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Zalam et al. (2026) conducted a case report in Acute coronary syndrome (n=1). Anabolic steroids and energy drinks (exposure) was evaluated. Heavy use of anabolic steroids and energy drinks in 1 young athlete (age 26) led to rapid progression from nonobstructive plaque to acute LAD thrombosis within weeks.
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