Dr Larry Santora heart disease and steroids:
Anabolic Steroids Can Cause Heart Disease
The Question: Are anabolic steroids dangerous? Can they cause heart disease?
The Answer: Anabolic steroids are a significant risk factor for cardiac disease and heart attacks.
The Facts:
Anabolic steroids are actually "designer drugs". They are synthetic substances that have varying properties and effects similar to testosterone. However, they are not testosterone. They improve recovery time from exercise, increase muscle mass and strength, and have a host of other testosterone like effects on the body, some not very good. It is impossible to do a "double blind" study (the most accurate type of study) to see if steroids shorten the life expectancy of a person. It would be unethical and never will be done. We published the only scientific evidence, in Preventive Cardiology, Fall 2006, that there is an association between steroid abuse and heart disease.
The Study:
We did the next best thing. We did a real life, observational study. At the Orange County Heart Institute, we studied 14 bodybuilders who used anabolic steroids for at least 10 years. They had no other known risk factors for heart disease. We did EBCT heart scans to detect plaque in the coronary arteries. This is the most accurate non invasive way to detect hardening of the arteries, the leading cause of heart attacks and death in men and women. A majority of the study subjects had premature and severe coronary artery disease. Several of the subjects in their early 30's had hardening of the arteries similar to a 75 year old man. The earlier in life you develop coronary artery plaque, the more likely you will die of a heart attack at an early age. Please see the article published in Preventive Cardiology, Fall 2006., go to Research Article tab on our web site: ocheart.org
The Reason:
We do not know the reason why anabolic steroids cause heart disease. Is is a direct toxic effect or irritant to the lining of the arteries, or is it an indirect means such as causing the good cholesterol, HDL cholesterol, to be very low and therefore promote plaque buildup. Everyone participant had HDL cholesterol in the 15 to 20 range (higher HDL is better, a level greater than 50 is protective). Certainly not everyone who takes anabolic steroids will get early heart disease, just like not everyone who smokes will get early heart disease, but the risk to your heart from abuse of steroids or cigarettes is very high and very real.
The Bottom Line:
Anabolic steroids cause heart disease, no question about it. Not everyone who abuses them will have a heart attack, but the risk is real. If you have been using steroids for 8 to 10 years, you should get an EBCT heart scan to see if you have developed hardening of the coronary arteries (see ocvitalimaging.com).
Lastly, don't confuse anabolic steroids with testosterone supplements in middle aged men. studies show that if you have a low level of testosterone, having testosterone supplementation to maintain your testosterone levels in the high normal range can actually protect your heart.
http://ocheartinstitute.com/PDFs/STEROIDPAPER.pdf
Coronary Calcium Scan
The mean coronary artery calcium score for the 14-person cohort was 98. This is near the coronary calcium score of 100 that is considered to place a patient at elevated risk for an event.
We found that they had significantly lower HDL-C levels than the typical population. The LDL-C and triglyceride levels were within the expected range for healthy active young men. The mean ratio of total cholesterol/HDL-C was unusually high, measuring 8.3.
The study appears to indicate that steroid abuse not only significantly lowers HDL-C, but contributes directly to the early development of coronary atherosclerosis as determined by the noninvasive measures of coronary artery calcium.
What is even more disturbing is that 3 of the subjects, each younger than 40 years of age, had significant calcium scores. It has been argued in publications that cater to body builders and weight lifters that these risks may be offset by exercise, diet, and the lowering of serum triglyceride levels associated with the use of anabolic steroids.
This pilot study is limited in several respects. First, it is impossible to report the exact doses, types, and duration of steroid use. The steroid users varied the intake over the years based on availability and what stage of training they were involved in. The steroid use is also all self-reported by the users, since none of the drugs were prescribed by a physician or bought at the usual retail outlets. Suffice it to say, the use is typical of the steroid users in the past and in the present, since all study patients were still using steroids.
CONCLUSIONS
This is the first study that has documented an association of steroid abuse and coronary artery calcification in steroid abusers.
The fact that these
relatively young study patients developed early coronary arteriosclerosis may have significant health and social implications.
We would expect that premature coronary events will occur in similar steroid abusers. Due to the rampant abuse of steroids from high school sports to the now well publicized abuse by professional sports figures,
we may expect an increase in cardiac events in otherwise healthy athletes when they reach their late 30s to mid-40s.
Summary
In summary, long-term steroid abuse is associated with an increased risk of coronary arteriosclerosis as measured by increased coronary calcium seen with electron beam computed tomographic imaging. We hope that this study will now bring to light the clear cardiovascular risk of steroid abuse and perhaps discourage future athletes from using steroids.
