ORIGINAL ARTICLE

Homocysteine induced cardiovascular events: a consequence of long term anabolic-androgenic steroid (AAS) abuse

M R Graham¹, F M Grace¹, W Boobier¹, D Hullin², A Kicman³, D Cowan³, B Davies¹, J S Baker¹

¹ Department of Exercise and Health Science, School of Applied Science, University of Glamorgan, Pontypridd, Wales, UK
² Department of Pathology, Royal Glamorgan Hospital, Mid-Glamorgan, Wales, UK
³ Drug Control Centre, Kings College London, London, UK

Correspondence to:
Michael R Graham
Health and Exercise Science Research Unit, School of Applied Science, University of Glamorgan, CF37 1DL, UK; drgraham{at}glam.ac.uk

Objectives: The long term effects (>20 years) of anabolic-androgenic steroid (AAS) use on plasma concentrations of homocysteine (HCY), folate, testosterone, sex hormone binding globulin (SHBG), free androgen index, urea, creatinine, haematocrit (HCT), vitamin B12, and urinary testosterone/epitestosterone (T/E) ratio, were examined in a cohort of self-prescribing bodybuilders.

Methods: Subjects (n = 40) were divided into four distinct groups: (1) AAS users still using AAS (SU; n = 10); (2) AAS users abstinent from AAS administration for 3 months (SA; n = 10); (3) non-drug using bodybuilding controls (BC; n = 10); and (4) sedentary male controls (SC; n = 10).

Results: HCY levels were significantly higher in SU compared with BC and SC (p<0.01), and with SA (p<0.05). Fat free mass was significantly higher in both groups of AAS users (p<0.01). Daily energy intake (kJ) and daily protein intake (g/day) were significantly higher in SU and SA (p<0.05) compared with BC and SC, but were unlikely to be responsible for the observed HCY increases. HCT concentrations were significantly higher in the SU group (p<0.01). A significant linear inverse relationship was observed in the SU group between SHBG and HCY (r = –0.828, p<0.01), indicating a possible influence of the sex hormones in determining HCY levels.

Conclusions: With mounting evidence linking AAS to adverse effects on some clotting factors, the significantly higher levels of HCY and HCT observed in the SU group suggest long term AAS users have increased risk of future thromboembolic events.

Abbreviations: AAS, anabolic-androgenic steroid; B12, vitamin B12; BC, bodybuilding controls; FAI, free androgen index; FFM, fat free mass; FFMI, fat free mass index; HCT, haematocrit; HCY, homocysteine; ROS, reactive oxygen species; SA, AAS abstinent subjects; SC, sedentary controls; SD, standard deviation; SHBG, sex hormone binding globulin; SU, AAS using subjects; TBM, total body mass; T/E, testosterone/epitestosterone; tHCY, total HCY

Keywords: bodybuilding; haematocrit; homocysteine; thromboembolism

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