Anabolics and Cardiomyopathy in a Bodybuilder: Case Report and Literature Review

doi:10.1016/j.cardfail.2008.12.014

Journal of Cardiac Failure

Volume 15, Issue 6, August 2009, Pages 496-500

https://doi.org/10.1016/j.cardfail.2008.12.014 Get rights and content

Abstract

Background

Athletes use androgenic-anabolic steroids to increase strength and muscle mass. Several case reports suggest that it may lead to dilated cardiomyopathy.

Methods and Results

We report a case of a 41-year-old bodybuilder with severe systolic dysfunction and Class IV heart failure despite maximal medical therapy. He used anabolic steroids and insulin growth factor, and did not have any other risk factors for cardiomyopathy. We briefly review the literature and summarize other reported cases with similar scenarios. In most of them cardiomyopathy was at least partially reversible after discontinuation of anabolics.

Conclusions

Abuse of anabolic steroids may be an uncommon cause of cardiomyopathy in young and otherwise healthy individuals.

Section snippets

Case Report

Our patient is a 41-year-old white male, previously semiprofessional, national class bodybuilder, who repeatedly ranked in the top 5 in his weight class in US national bodybuilding championships. He first presented to the emergency room of our hospital in 2007 because of abdominal tenderness and a 2-week history of nausea, vomiting, and intermittent dyspnea. He reported a history of AAS abuse; he had stopped using AAS 1 year before this admission. He also stated that he had previously been

Discussion

Several case reports have linked adverse cardiac events and AAS abuse in healthy young athletes. These events have included acute myocardial infarction,1, 2, 3, 4, 5 sudden cardiac death,6, 7, 8 ventricular fibrillation with exercise,⁹ atrial fibrillation,10, 11 cardiac tamponade,¹² and development of dilative cardiomyopathy.9, 13, 14, 15, 16 Considering the high prevalence of AAS abuse particularly within the group of athletes participating in strength disciplines group,¹⁷ the number of cases

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Cited by (63)

Androgenic Steroids Use and Abuse: Past, Present, and Future
2022, Urologic Clinics of North America
Anabolic-androgenic steroid use in a young body-builder: A case report and review of the literature
2022, Annals of Medicine and Surgery
Anabolic-androgenic steroid (AAS) abuse is routine in athletes to enhance their overall physique. It often leads to detrimental effects, including cardiovascular diseases, hormonal imbalances, and cancer. Our case presentation emphasizes two important aspects: the first is the importance of thorough history taking in correctly diagnosing diseases with multiple etiologies. The second one relates to the reversible and preventable hazards of the increasing incidence of usage of illicit drugs, mainly androgenic anabolic steroids in young adults.
We present a case of a 30-year-old male bodybuilder with presenting complaints of increased anxiousness, excessive anger, and dyspnea on minimal exertion. Echocardiogram showed a dilated cardiomyopathy with left ventricular ejection fraction (LVEF) of 20%. The patient was counseled for quitting AAS and symptomatically treated on heart failure management guidelines. He responded well to the management plan and now enjoying a healthy life.
It is imperative to raise awareness regarding the substantial adverse effects of AAS abuse that might precipitate severe cardiovascular system complications leading to morbidity and eventual mortality. Most of the times, the pathological changes due to AAS abuse are reversible. This shows a good prognosis and better compliance with the management plan advised to the patients.
Muscle-building behaviors from adolescence to emerging adulthood: A prospective cohort study
2022, Preventive Medicine Reports
Citation Excerpt :
Similarly, performance-enhancing substances are largely underregulated by the FDA, may be adulterated with illicit and harmful substances (Cohen et al., 2018; Ganson et al., 2020b), may signal an unhealthy preoccupation with body shape and size, and have been linked to severe medical events and death (Or et al., 2019). Anabolic-androgenic steroid use is associated with mood disorders, aggression, violence (Pope et al., 2014), teen dating violence (Ganson and Cadet, 2019), and substance use disorders (Lundholm et al., 2010), as well as several medical complications related to key systems of the body (e.g., cardiovascular, neuroendocrine) (Ahlgrim and Guglin, 2009; Bispo et al., 2009; Daly et al., 2003; Nikolopoulos et al., 2011). Moreover, use of muscle-building products, such as creatine, has been identified as a potential predictor of problematic use of alcohol (Ganson et al., 2020a) and anabolic steroids (Nagata et al., 2020b); however, little is known about how more common muscle-building behaviors may be associated with future use of more hazardous muscle-building products.
This study aimed to identify patterns of change in muscle-building behaviors from adolescence to emerging adulthood and determine what adolescent factors predict new-onset muscle-building behavior in emerging adulthood. Prospective cohort data from a diverse sample of 1,535 participants followed from adolescence (baseline, M_age = 14.4 ± 2.0 years) to emerging adulthood (follow-up, M_age = 22.1 ± 2.0 years) from the population-based EAT 2010–2018 (Eating and Activity over Time) study were analyzed. Changes in muscle-building behavior were identified (starting, stopping, persistent use, or never use). Log-binomial regression models examined adolescent predictors of starting (i.e., new-onset) muscle-building behaviors in emerging adulthood. Prevalence of any use in adolescence (EAT 2010) and/or emerging adulthood (EAT 2018) was 55.1% (males) and 33.0% (females) for protein powder/shakes, 6.7% (males) and 5.4% (females) for steroids, and 19.4% (males) and 6.5% (females) for other muscle-building substances (e.g., creatine, amino acids). In particular, 22.6% (males) and 13.7% (females) started protein powder/shakes, 2.2% (males) and 1.0% (females) started steroid use, and 9.0% (males) and 2.0% (females) started other muscle-building substances during emerging adulthood. Adolescent protein powder/shake consumption was associated with starting steroids/other muscle-building substances use in emerging adulthood in males (adjusted risk ratio [ARR] 2.09, 95% confidence interval [CI] 1.29–3.39) and females (ARR 4.81, 95% CI 2.01–11.48). Adolescent use of protein powders/shakes may lead to a two- to five-fold higher risk of new use of steroids and other muscle-building products in emerging adulthood. Clinicians, parents, and coaches should assess for use of muscle-building behaviors in adolescents and emerging adults and discourage use of harmful products.
Performance-enhancing substance use and criminal offending: A 15-year prospective cohort study
2021, Drug and Alcohol Dependence
Research has documented an association between anabolic-androgenic steroid (AAS) use and criminal offending. Still, whether legal performance-enhancing substance (e.g., creatine; PES) use is similarly associated with criminal offending is unknown. The aim of the present study was to determine the prospective associations between legal PES use and AAS use and criminal offending among U.S. adults.
Data from three waves over 15 years of the National Longitudinal Study of Adolescent to Adult Health, a prospective cohort study, were analyzed. Legal PES use and AAS use were assessed at Wave III (ages 18−26) and criminal offending was assessed at Wave IV (ages 24−32; N = 10,861) and Wave V (ages 33–43; N = 9,451). Criminal offending was measured using a summed score of six items (range 0–6). Multiple negative binominal regressions were conducted, transformed to incident rate ratios (IRR), adjusting for biological sex, age, race/ethnicity, household income, body mass index, depression, smoking, alcohol, and prior victimization and offending.
Among the sample (51.3 % male; 68.8 % White), legal PES use (Wave IV: IRR 1.46, 95 % confidence interval [CI] 1.15−1.85; Wave V: IRR 1.52, 95 % CI 1.02−2.27) and AAS use (Wave IV: IRR 1.73, 95 % CI 1.09−2.76; Wave V: IRR 2.36, 95 % CI 1.33−4.19) were prospectively associated with criminal offending during young and middle adulthood, while adjusting for demographic and behavioral factors.
These results confirm and expand upon prior research by describing the prospective associations between both legal PES use and AAS use and criminal offending among a nationally representative sample of U.S. adults.
Anabolic Androgenic Steroid Use as a Cause of Fulminant Heart Failure
2018, Canadian Journal of Cardiology
Citation Excerpt :
Our case report is unique in several features. The severity of fulminant heart failure, necessitating immediate resuscitation and advanced life support, has not previously been described and suggests potential additional underpinning pathophysiologic mechanisms.2 Moreover, we have specified the exact forms, dosages, and timeframe over which the patient abused AAS: details critical to appreciating the risk of toxicity.
A 39-year-old male weightlifter presented in fulminant heart failure. An echocardiogram revealed severe global biventricular failure. Left ventricular (LV) systolic function was estimated at 15%. His dilated cardiomyopathy was attributed to his use of both testosterone and boldenone in the 3-month period before his presentation. Although the deleterious effects of androgenic- anabolic steroids on diastolic function are well known, the effects of these drugs on systolic function is an area of ongoing investigation. Our case suggests that androgenic anabolic steroid use should be considered in the differential diagnosis of patients presenting with acute heart failure.
Un homme âgé de 39 ans, pratiquant l’haltérophilie, a présenté une insuffisance cardiaque fulminante. Une échocardiographie a révélé une insuffisance biventriculaire globale grave. Sa fonction systolique ventriculaire gauche était estimée à 15 %. Sa cardiomyopathie dilatée a été imputée au fait qu’il avait pris à la fois de la testostérone et du boldénone au cours des 3 mois précédant cet événement. Si les effets nocifs des stéroïdes anabolisants androgènes sont bien connus, les effets de ces médicaments sur la fonction systolique font encore l’objet d’études. Le cas que nous présentons laisse croire que l’utilisation de stéroïdes anabolisants androgènes devrait être prise en considération dans le diagnostic différentiel des patients présentant une insuffisance cardiaque aiguë.
Development of an extraction method for anabolic androgenic steroids in dietary supplements and analysis by gas chromatography-mass spectrometry: Application for doping-control
2018, Steroids
Several studies have highlighted that nutritional supplements may contain undeclared anabolic steroids that are banned by the International Olympic Committee/World Anti-Doping Agency. Any kind of abuse with these drugs is extremely dangerous because of their side effects. Thus, the control of food additives in order to protect the best consumer health and to limit fraudulent practices in the field of sports is essential.
This paper describes a simple and effective qualitative gas chromatography-mass spectrometry (GC–MS) method to detect anabolic androgenic steroids (AAS): androsterone, nandrolene, dehydroepiandrosterone, 5ɑ-androstane-3β, 17β-diol, dihydrotestosterone, testosterone, methenolone acetate, methandienone, boldenone and fluoxymesterone, in food supplements. Methyltestosterone was used as internal standard. Target compounds were extracted with a mixture of N-pentane and di-ethylether (7.5:2.5, v/v). A good extraction recovery was obtained by our method for all the AAS (R > 88%). Crude extract was derivatized with N-methyl-N-trimethylsilyl-trifluoracetamide. Separation was performed on a GC connected to quadrupole MS detector using a 5% phenylmethylsiloxane fused silica capillary column (30 m × 0.25 mm i.d.; film thickness, 0.25 µm). Helium was used as carrier gas with a flow rate of 0.3 µl min⁻¹ (measured at 6.1 psi 190 °C). The MS was operated in electron ionization mode (70 eV) and in selected ion monitoring (SIM). The mass spectra of the standard compounds were acquired in full SCAN mode (50–700 m/z) by infusion of a reference solution at 50 µg/ml. Three higher diagnostic ions were monitored for each compound of interest.
All AAS get separated with good peak shapes and resolution factor. The total analysis time by our optimised method was only 20 min. The developed method was validated according to Laboratories International Standard regulations for specificity, precision in both liquid and solid matrixes, and memory effect. The Tolerance Interval was judged true. The limit of detection was about 10 ng/g for solid samples and 10 ng/ml for liquid samples. The developed method was then applied to the research of steroids in nine Tunisian commercially dietary supplements using for each compound of interest SIM mode for screening then SCAN mode for confirmation. One of the monitoring samples was positive to methandienone not declared on the label. Our analytical method can be beneficial for AAS screening in dietary supplements.

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Clinical InvestigationAnabolics and Cardiomyopathy in a Bodybuilder: Case Report and Literature Review

Abstract

Background

Methods and Results

Conclusions

Section snippets

Case Report

Discussion

Int J Cardiol

J Emerg Med

Int J Cardiol

Baillieres Best Pract Res Clin Endocrinol Metab

Am J Cardiol

Clin Sports Med

J Am Coll Cardiol

Myocardial infarction with extensive intracoronary thrombus induced by anabolic steroids

Br J Clin Pract

[Myocardial infarction and anabolic steroid use. A case report]

Arch Mal Coeur Vaiss

[Acute myocardial infarction in a young man who had been using androgenic anabolic steroids]

Tidsskr Nor Laegeforen

[Myocardial infarction and death of a body builder after using anabolic steroids]

Ugeskr Laeger

Sudden cardiac death in a 20-year-old bodybuilder using anabolic steroids

Cardiology

Performance enhancing drugs (doping agents) and sudden death—a case report and review of the literature

Int J Legal Med

Anabolic steroid abuse and cardiac death

Med J Aust

Serious cardiovascular side effects of large doses of anabolic steroids in weight lifters

Eur Heart J

Cardiac tamponade in a 21-year-old body builder with anabolica abuse

Br J Clin Pract

Anabolic steroid use as the possible precipitant of dilated cardiomyopathy

Cardiology

Dilated cardiomyopathy and acute liver injury associated with combined use of ephedra, gamma-hydroxybutyrate, and anabolic steroids

Pharmacotherapy

Clinical Investigation
Anabolics and Cardiomyopathy in a Bodybuilder: Case Report and Literature Review