Subscribe to RSS
DOI: 10.1055/s-2003-40702
Anabolic Androgenic Steroids Produce Dose-Dependent Increase in Left Ventricular Mass in Power Athletes, and this Effect is Potentiated by Concomitant Use of Growth Hormone
Publication History
Accepted after revision: January 15, 2003
Publication Date:
17 July 2003 (online)
![](https://www.thieme-connect.de/media/sportsmed/200305/lookinside/thumbnails/10.1055-s-2003-40702-1.jpg)
Abstract
Power athletes abuse anabolic androgenic steroids (AASs) and growth hormone (GH) to gain their muscular mass and strength. We wanted to determine how massive, self-administered doses of AASs with or without GH affect the left ventricular (LV) dimensions in power athletes. These substances are assumed to increase LVmass mainly by thickening the ventricular walls. Anecdotal evidence suggests a higher risk of cardiovascular events in AAS abusers. We were interested to see if LV dimensions and function in AAS abusers would indicate this increased risk. Twenty healthy male power athletes using massive doses of AAS without (n = 16) or with (n = 4) GH volunteered for the study. The controls were 15 sedentary male non-users of hormones. LV mass, geometry and filling were studied using standard echocardiographic methods. We found a significant association between LV mass and AAS dose (r = 0.54, p < 0.015). In contrast to the controls, LV mass (274 g in the athletes, 167 g in the controls) among the AAS abusers did not correlate with body weight or height. Concomitant use of AAS and GH further increased LV mass and associated with concentric remodelling of LV. Multiple regression analysis indicated that the mean AAS dose accounted for 29 %, age for 14 % and systolic blood pressure for 17 % of the variance in LV mass. We concluded that AAS abuse associates dose-dependently with myocardial hypertrophy and that concomitant use of GH associates with concentric remodelling of the LV. Our findings suggest that AASs and GH have a direct effect on the myocardium.
Key words
Substance abuse - left ventricular hypertrophy
References
- 1 Behrent H, Boffin H. Myocardial cell lesions caused by anabolic hormone. Cell Tissue Res. 1977; 181 423-426
- 2 Bhasin S, Storer T W, Berman N, Callegari C, Clevenger B, Phillips J, Bunnell T J, Tricker R, Shirazi A, Casaburi R. The effects of supraphysiologic doses of testosterone on muscle size and strength in normal men. N Engl J Med. 1996; 335 1-7
- 3 Caidahl K, Edén S, Bengtsson B Å. Cardiovascular and renal effects of growth hormone. Clin Endoc. 1994; 40 393-400
- 4 Deligiannis A P, Mandroukas K. Noninvasive cardiac evaluation of weightlifters using anabolic steroids. Scand J Med Sci Sports. 1992; 3 37-40
- 5 de Piccoli B, Giada F, Benettin A, Sartori F, Piccolo E. Anabolic steroid use in body builders: an echocardiographic study of left ventricular morphology and function. Int J Sports Med. 1991; 12 408-412
- 6 Devereux R B. Detection of left ventricular hypertrophy by M-mode echocardiography. Hypertension. 1987; 9(suppl II) 19-26
- 7 Dickerman R D, Schaller F, McConathy W J. Left ventricular wall thickening does occur in elite power athletes with or without anabolic steroid use. Cardiology. 1998; 90 145-148
- 8 Dickerman R D, Schaller F, Zachariah N Y, McConathy W J. Left ventricular size and function in elite bodybuilders using anabolic steroids. Clin J Sport Med. 1997; 7 90-93
- 9 Donike M, Geyer H, Gotzmann A, Kraft M, Mandel F, Nolteernsting E, Opfermann G, Sigmund G, Schänzer W, Zimmermann J. Dope Analysis. Official Proceedings of International Athletic Foundation World Symposium on Doping in Sport - 1987. In Bellotti P, Benzi G, Ljungqist A, ed London; Published by the International Athletic Foundation 1988: 53-80
- 10 Fazio S, Sabatini D, Capaldo B, Vigorito C, Giordano A, Guida R, Pardo F, Biondi B, Sacca L. A preliminary study of growth hormone in the treatment of dilated cardiomyopathy. N Engl J Med. 1996; 334 809-814
- 11 Kahaly G, Olshausen K V, Mohr-Kahaly S, Erbel R, Boor S, Beyer J, Meyer J. Arrhythmia profile in acromegaly. Eur Heart J. 1992; 13 51-56
- 12 Karjalainen J, Mäntysaari M, Viitasalo M, Kujala U. Left ventricular mass, geometry, and filling in endurance athletes: association with exercise blood pressure. J Appl Physiol. 1997; 82 531-537
- 13 Karila T AM, Koistinen H, Seppälä M, Koistinen R, Seppälä T A. Growth hormone induced increase in serum IGFBP-3 level is reversed by anabolic steroid in substance abusing power athletes. Clin Endoc. 1998; 49 459-463
- 14 Klein I, Ojamaa K. Cardiovascular manifestations of endocrine disease. J Clin Endocrinol Metab. 1992; 75 339-342
- 15 Krieg M, Smith K, Bartsch W. Demonstration of a specific androgen receptor in rat heart muscle: relationship between binding, metabolism, and tissue levels of androgens. Endocrinology. 1978; 103 1686-1694
- 16 Lie J T, Grossman S J. Pathology of the heart in acromegaly: anatomic findings in 27 autopsied patients. Am Heart J. 1980; 100 41-52
- 17 Lim M, Barkan A L, Buda A J. Rapid reduction of left ventricular hypertrophy in acromegaly after suppression of growth hormone hypersecretion. Ann Int Med. 1992; 117 719-726
- 18 Maron B J. Structural features of the athlete heart as defined by echocardiography. J Am Coll Cardiol. 1986; 7 190-203
- 19 Marsh J D, Lehmann M H, Ritchie R H, Gwathmey J K, Green G E, Schiebinger R J. Androgen receptors mediate hypertrophy in cardiac myocytes. Circulation. 1998; 98 256-261
- 20 Mathews L S, Enberg B, Norstedt G. Regulation of rat growth hormone reseptor gene expression. J Biol Chem. 1989; 17 9905-9910
- 21 Melchert R B, Herron T J, Welder A A. The effect of anabolic-androgenic steroids on primary myocardial cell cultures. Med Sci Sports Exerc. 1992; 24 266-272
- 22 NIDA Research Report - Steroid Abuse and Addiction: NIH Publication No. 00 - 3721, Revised April,. 2000
- 23 Nieminen M S, Rämo M P, Viitasalo M, Heikkila P, Karjalainen J, Mantysaari M, Heikkila J. Serious cardiovascular side effects of large doses of anabolic steroids in weight lifters. Eur Heart J. 1996; 17 1576-1583
- 24 Osterziel K J, Strohm O, Schuler J, Friedrich M, Hanlein D, Willenbrock R, Anker S D, Poole-Wilson P A, Ranke M B, Dietz R. Randomised, double-blind, placebo-controlled trial of human recombinant growth hormone in patients with chronic heart failure due to dilated cardiomyopathy. Lancet. 1998; 351 1233-1237
- 25 Palatini P, Giada F, Garavelli G, Sinisi F, Mario L, Michieletto M, Baldo-Enzi G. Cardiovascular effects of anabolic steroids in weight-trained subjects. J Clin Pharmacol. 1996; 36 1132-1140
- 26 Pearson A C, Schiff M, Mrosek D, Labovitz A J, Williams G A. Left ventricular diastolic function in weight lifters. Am J Cardiol. 1986; 58 1254-1259
- 27 Pelliccia A, Maron B J, Spataro A, Proschan M A, Spirito P. The upper limit of physiologic cardiac hypertrophy in highly trained elite athletes. N Engl J Med. 1991; 324 295-301
- 28 Pelliccia A, Spataro A, Caselli G, Maron B J. Absence of left ventricular wall thickening in athletes engaged in intense power training. Am J Cardiol. 1993; 72(14) 1048-1054
- 29 Rockhold R W. Cardiovascular toxity of anabolic steroids. Annu Rev Pharmacol Toxicol. 1993; 33 497-520
- 30 Rossi E, Zuppi P, Pennestri F, Biasucci L M, Lombardo A, de Marinis L, Loperfido F. Acromegalic cardiomyopathy: left ventricular filling and hypertrophy in active and surgically treated disease. Chest. 1992; 102 204-208
- 31 Rämö P. Anabolic steroids alter the hemodynamic response of the canine left ventricle. Acta Physiol Scand. 1987; 130 209-217
- 32 Sachtleben T R, Berg K E, Elias B A, Cheatham J P, Felix G L, Hofschire P J. The effects of anabolic steroids; on myocardial structure and cardiovascular fitness. Med Sci Sport Exec. 1993; 25 1240-1245
- 33 Shapiro L M. Physiological left ventricular hypertrophy. Br Heart J. 1984; 52 130-135
- 34 Smallridge R C, Rajfer S, Davia J, Schaaf M. Acromegaly and the heart: an echocardiographic study. Am J Med. 1979; 66 22-27
- 35 Stolt A, Karila T, Viitasalo M, Mäntysaari M, Kujala U, Karjalainen J. QT interval and QT dispersion in endurance athletes and in power athletes using large doses of anabolic steroids. Am J Cardiol. 1999; 84 364-366
- 36 Thompson P D, Sadaniantz A, Cullinane E M, Bodziony K S, Catlin D H, Torek-Both G, Douglas P S. Left ventricular function is not impaired in weight lifters who use anabolic steroids. J Am Coll Cardiol. 1992; 19 278-282
- 37 Tomoda H. Effect of Oxymetholone on left ventricular dimensions in heart failure secondary to idiopathic dilated cardiomyopathy or to mitral or aortic regurgitation. Am J Cardiol. 1999; 83 123-125
- 38 Urhausen A, Hölpes R, Kindermann W. One- and two-dimensional echocardiography in bodybuilders using anabolic steroids. Eur J Appl Physiol. 1989; 58 633-640
T. Karila
Laboratory of Substance Abuse · National Public Health
Institute
Mannerheimintie 166 F · 00300 Helsinki · Finland
·
Phone: +358 9 4744 8425
Fax: +358 9 4744 8553
Email: tuomo.karila@ktl.fi