The Impact of Anabolic-Androgenic Steroid Use on the Cardiovascular System in Bodybuilding: A Systematic Review

Anabolic androgenic steroids (AAS) represent a group of synthetic testosterone derivatives produced to maximize anabolic effects. Widely used worldwide, especially among male bodybuilders and gym-goers, ASS can be administered orally, parenterally, by intramuscular injection and transdermally. AAS cause a dose- dependent increase in the cross-sectional area of hypertrophy type I and type II muscle fibers and myonuclear areas. It has been reported that ASS may protect from muscle fiber damage and increase the level of protein synthesis during recovery, especially after intense strength training. In this systematic review study, full-text articles published in the last ten years (2014- 2024) in journals in Science Citation Index (SCI), SCI Expanded, Social Science Citation Index (SSCI) and PubMed/MEDLINE databases investigating the relationship between testosterone and cardiovascular diseases were analyzed. "Anabolic steroids", "androgens", "anabolic androgenic steroids", "bodybuilding", "cardiovascular effects" and "doping in sports" used as keywords. A total of 9 articles that met the specified conditions were analyzed. The diagnosis of cardiac arrest as a cause of death from ASS-induced cardiac arrest reveals the occurrence of pathological changes in the myocardium, including cardiac and left ventricular hypertrophy, coronary atherosclerosis, myocarditis, interstitial and replacement fibrosis, and contraction band necrosis. Long-term abuse and misuse of ASS can increase the risk of sudden cardiac death (SCD), myocardial infarction, altered serum lipoproteins and cardiac hypertrophy, which can be particularly fatal to the cardiovascular system. Most studies agree that the longer AAS use lasts, the worse the risk profile for cardiovascular disease and that ASS should be determined by the duration of use. There is substantial evidence that AAS is the primary cause of sudden cardiac death in AAS users.