Anabolic-androgenic steroids on cardiac structure and function in resistance-trained athletes: A systematic review and meta-analysis

Abstract

Background

Anabolic-androgenic steroids (AAS) are widely used by resistance-trained athletes, but their effects on cardiac structure and function remain uncertain.

Objective

To assess the impact of AAS on cardiac structure and function using echocardiography.

Methods

We performed a systematic review and meta-analysis to assess the effects of AAS on echocardiographic parameters in athletes, using a random-effects model and Review Manager 5.4.1.

Results

We included 35 studies with 2000 male individuals (834 resistance-trained athletes using AAS vs 754 resistance-trained non-users vs 412 sedentary controls; mean age 32 years). Compared with non-users of AAS, AAS users was associated with a decrease in left ventricular (LV) ejection fraction (MD -2.25 %; 95 % CI -3.41 to −1.09; p < 0.01), and global longitudinal strain (GLS) (MD 3.34 %; 95 % CI 2.93 to 3.76; p < 0.01). Athletes who used AAS also had an increased septal wall thickness (MD 1.24 mm; 95 % CI 0.79 to 1.69; p < 0.01), posterior wall thickness (MD 1.09 mm; 95 % CI 0.70 to 1.48; p < 0.01) and LV mass (MD 13.29 g; 95 % CI 6.25 to 20.33; p < 0.01). LV end-diastolic diameter was also higher among AAS users (MD 1.09 mm; 95 % CI 0.44 to 1.73; p < 0.01).

Conclusion

Among athletes, AAS was associated with a significant decrease in LV ejection fraction and GLS, alongside with increased septal and posterior wall thickness, LV mass, and end-diastolic diameter compared with athletes who do not use AAS. These findings suggest adverse cardiac remodeling in AAS users, highlighting the potential harmful cardiovascular effects of steroid use in athletes.