Long-Term Anabolic-Androgenic Steroid Use Is Associated With Left Ventricular Dysfunction

BACKGROUND: Although illicit anabolic-androgenic steroid (AAS) use is widespread, the cardiac effects of long-term AAS use remain inadequately characterized. We compared cardiac parameters in weightlifters reporting long-term AAS use to those in otherwise similar weightlifters without prior AAS exposure. METHODS AND RESULTS: We performed 2D tissue-Doppler and speckle-tracking echocardiography to assess left ventricular (LV) ejection fraction, LV systolic strain, and conventional indices of diastolic function in long-term AAS users (n=12) and otherwise similar AAS nonusers (n=7). AAS users (median quartile 1, quartile 3 cumulative lifetime AAS exposure, 468 169, 520 weeks) closely resembled nonusers in age, prior duration of weightlifting, and current intensity of weight training. LV structural parameters were similar between the two groups; however, AAS users had significantly lower LV ejection fraction (50.6% 48.4, 53.6 versus 59.1% 58.0%, 61.7%; P=0.003 by two-tailed Wilcoxon rank sum test), longitudinal strain (16.9% 14.0%, 19.0% versus 21.0% 20.2%, 22.9%; P=0.004), and radial strain (38.3% 28.5%, 43.7% versus 50.1% 44.3%, 61.8%; P=0.02). Ten of the 12 AAS users showed LV ejection fractions below the accepted limit of normal (>or=55%). AAS users also demonstrated decreased diastolic function compared to nonusers as evidenced by a markedly lower early peak tissue velocity (7.4 6.8, 7.9 cm/s versus 9.9 8.3, 10.5 cm/s; P=0.005) and early-to-late diastolic filling ratio (0.93 0.88, 1.39 versus 1.80 1.48, 2.00; P=0.003). CONCLUSIONS: Cardiac dysfunction in long-term AAS users appears to be more severe than previously reported and may be sufficient to increase the risk of heart failure.