Anabolic androgenic steroids use tied to impaired myocardial flow reserve persistent coronary microvascular dysfunction: JAMA

A new study published in the Journal of American Medical Association showed that young males who use or have previously used anabolic-androgenic steroids (AASs) are more likely to have a lower myocardial flow reserve when compared to those who have never used the medicines.

Although the exact mechanism of development is unknown, long-term use of anabolic androgenic steroids is linked to a significant risk of left ventricular hypertrophy, heart failure with impaired systolic function, and early abrupt death. In the men who use AAS, early and persistently decreased myocardial microcirculation may be clinically significant, a possible underlying cause of frequent and early heart illness, and a future target for treatments.

This study used cardiac rubidium 82 (82Rb) positron emission tomography/computed tomography (PET/CT) to measure myocardial flow reserve (MFR) in males who now and previously used AAS in comparison to controls who had never used AAS. This was done to evaluate coronary microcirculation.

Men who participated in recreational strength training and did not have a history of cardiovascular disease were included in this cross-sectional study based on their history of using AAS. From November 24, 2021, until August 16, 2023, the study was carried out. The MFR between the research groups was the main result of this investigation, while the coronary calcium score was the secondary result. By definition, a threshold of MFR less than 2 was used to identify impaired myocardial microcirculation, while a cutoff of MFR less than 2.5 was used to identify sub-clinically impaired microcirculation.

There were 90 men in all and 35.1 years was the mean (SD) age. A 1.5-year geometric mean was the amount of time that had passed from AAS discontinuation. Before enrolling, 18 males (58.1%) who had previously used AAS stopped using it more than a year earlier. Impaired MFR was seen in individuals with current and past usage, but no impairment was detected among the controls. When compared to the controls, men who now or previously used AAS had a greater sub-clinically impaired MFR.

Every doubling of the total weekly duration of AAS usage (log2) was independently linked to a factor 2 increase in the chance of impaired MFR less than 2.5 in a multivariable logistic regression model among men who had previously used AAS. Overall, both present and previous AAS users in this cross-sectional research showed reduced MFR which indicated a link between AAS use and lower MFR.

Reference:

Bulut, Y., Rasmussen, J. J., Brandt-Jacobsen, N., Frystyk, J., Thevis, M., Schou, M., Gustafsson, F., Hasbak, P., & Kistorp, C. (2024). Coronary Microvascular Dysfunction Years After Cessation of Anabolic Androgenic Steroid Use. In JAMA Network Open (Vol. 7, Issue 12, p. e2451013). American Medical Association (AMA). https://doi.org/10.1001/jamanetworkopen.2024.51013