The cardiovascular risk of doping and substance abuse in athletes.

While doping has been present since the ancient era, the (mis)use of doping has grown exponentially over the recent years, reaching all different levels of sport activity, ranging from the professional young athlete to the master athlete till the amateur leisure-time athlete, which represents an overall dramatic increase and a loss of fair competition. Not only doping is illegal, but it can cause significant adverse side effects, particularly on the cardiovascular (CV) system. These effects are among the most harmful, determining serious CV conditions and diseases and contributing to the increase of CV morbidity and mortality among users of performance-enhancing substances. It is important to note that different factors impact on the severity of the CV side effects, as the type of substance, the dose (usually higher than the therapeutic one) and duration of intake, as well as the epigenetic effect and interindividual variability. Aim of this review is to report the most updated scientific evidence of the adverse CV effects of doping and its potential as a non-traditional cardiovascular risk factor. In addition, we aim to spread the knowledge on the potential CV risk of doping in physicians, athletes, coaches and in the general population to increase awareness and promote fair competition in sports.