Cardiovascular Disease in Anabolic Androgenic Steroid Users.

Summary

In a matched nationwide cohort, anabolic-androgenic steroid users had markedly elevated risks of MI, revascularization, VTE, arrhythmias, cardiomyopathy (aHR ~9), and heart failure over ~11 years. These robust associations quantify the cardiovascular burden of AAS use.

Key Findings

• AAS users had a threefold higher risk of acute MI (aHR 3.00) and nearly threefold higher need for PCI/CABG (aHR 2.95).
• Cardiomyopathy risk was profoundly increased (aHR 8.90), with elevated risks of HF (aHR 3.63) and arrhythmias (aHR 2.26).
• Venous thromboembolism risk was also higher (aHR 2.42), underscoring systemic thromboinflammatory effects.

Clinical Implications

Clinicians should screen for AAS exposure in young/middle-aged men with cardiomyopathy, arrhythmias, or premature ASCVD; counsel cessation and monitor cardiac function.

Limitations

• Selection limited to sanctioned users; exposure misclassification (dose/duration) possible.
• Residual confounding cannot be excluded; stroke/cardiac arrest underpowered.

Future Directions

Prospective mechanistic studies on AAS cardiotoxicity, dose-response, and reversibility; evaluate screening pathways and cessation interventions to reduce CVD burden.