The SA Journal Diabetes & Vascular Disease Vol 14 No 2 (December 2017)

SA JOURNAL OF DIABETES & VASCULAR DISEASE

RESEARCH ARTICLE

VOLUME 14 NUMBER 2 • DECEMBER 2017

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Anabolic androgenic steroids may be associated with early coronary

artery disease

nabolic androgenic steroids may be

associated with early coronary artery

disease, according to research presented at

the Brazilian Congress of Cardiology 2017.

‘Anabolic androgenic steroid abuse among

young people is a widespread problem

worldwide, and adverse events such as

sudden cardiac death and heart attack have

been reported in athletes,’ said lead author

Francis Ribeiro de Souza, PhD student, Heart

Institute, Medical School, University of São

Paulo, Brazil.

‘In Brazil, around one million people

have used anabolic androgenic steroids at

least once, and they are the seventh most

commonly used drug in the country,’ he

added.

This study examined whether anabolic

androgenic steroids could be associatedwith

early coronary artery disease. It also tested

whether reduced high-density lipoprotein

(HDL) function could be a mechanism

leading to coronary artery disease in

anabolic androgenic steroid users.

The study included 51 men with an

average age of 29 years (range 23–43

years). Of those, 21 did weight lifting and

had taken anabolic androgenic steroids for

at least two years, 20 did weight lifting but

did not take steroids, and 10 were healthy

but sedentary.

Participants underwent computed tomo-

graphy coronary angiography to assess the

presence of atherosclerosis in the coronary

arteries. A urine test was performed in all

participants to confirm steroid use. Blood

samples were taken to measure lipid levels

including HDL. The researchers used cell

cultures to measure the ability of each

participant’s HDL to perform its normal

function of removing cholesterol from

macrophages.

The researchers found that 24%of steroid

users had atherosclerosis in their coronary

arteries, compared to none of the non-users

and sedentary participants. The steroid users

with atherosclerosis also had significantly

reduced HDL levels and HDL function.

Mr Ribeiro de Souza said: ‘Our study

suggests that anabolic androgenic steroiduse

may be associated with the development of

coronary artery disease in apparently healthy

young people. Steroids may have an impact

on the ability of HDL to remove cholesterol

from macrophages, thereby promoting

atherosclerosis.’

‘This was a small, observational study

and we cannot conclude that steroids

cause atherosclerosis,’ he continued. ‘Larger

studies with longer follow up are needed to

confirm these results.’

Mr Ribeiro de Souza concluded: ‘We

observed coronary atherosclerosis in young

anabolic androgenic steroid users, which

in combination with lower HDL levels

and reduced HDL function could increase

the risk of cardiovascular events. Greater

awareness is needed of the potential risks

of these drugs.’

Dr Raul Santos, scientific chair of SBC

2017, said: ‘This study, despite its small

sample size, is well done and calls attention

to a possible important health problem in

Brazil and elsewhere since it shows not only

the classic lipid disturbances induced by

steroids but actually associates them with

the subclinical presence of atherosclerosis,

something that we are not supposed to find

in young individuals.’

Prof Fausto Pinto, ESC immediate

past president and course director of the

ESC programme in Brazil, said: ‘This is an

important issue in cardiovascular prevention

that deserves further study.