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Seara FAC, Pereira-Junior PP, Silva-Almeida C, Dos-Santos RC, Souza RN, Costa CRM, Domingos AE, Barbosa RAQ, Ferraz AP, Machado AAN, Ceccato VM, Takiya CM, Ponte CG, Reis LC, Olivares EL, Nascimento JHM. Anabolic steroid excess promotes hydroelectrolytic and autonomic imbalance in adult male rats: Is it enough to alter blood pressure? Steroids 2020; 163:108711. [PMID: 32739291 DOI: 10.1016/j.steroids.2020.108711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/20/2020] [Accepted: 07/27/2020] [Indexed: 11/29/2022]
Abstract
AIM The present study investigated the effects of anabolic steroid (AS) excess on blood pressure regulation. METHODS Male Wistar rats were treated with nandrolone decanoate (AS) or vehicle (CTL) for 8 or 10 weeks. Saline (1.8%) and water intake were measured in metabolic cages. Urinary volume, osmolarity, Na+ and K+ concentrations, and plasma osmolarity were measured. The autonomic balance was estimated by heart rate variability at baseline or after icv injection of losartan. Cardiac function was assessed by echocardiography and ex vivo recordings. Myocardial collagen deposition was evaluated by Picrosirius-Red staining. Vascular reactivity and wall thickness were investigated in aortic sections. Blood pressure (BP) was assessed by tail-cuff plethysmography. Angiotensin II type I receptor (AT1R), renin, and mineralocorticoid receptor (MR) mRNA expression was measured in the kidneys and whole hypothalamus. RESULTS AS group exhibited decreased urinary volume and Na+ concentration, while urinary K+ concentration, plasma osmolarity, and renal AT1R and renin mRNA levels were increased compared to CTL (p < 0.05). Water intake was increased, and saline intake was decreased in the AS group (p < 0.01). AS group exhibited increased low-frequency/high-frequency-ratio, while it was decreased by icv injection of losartan (p < 0.05) compared to baseline. Neither cardiac function nor vascular reactivity/morphology was affected by AS excess (p > 0.05). Ultimately, BP levels were not altered by AS excess (p > 0.05). CONCLUSION AS excess promoted hydroelectrolytic and autonomic imbalance but did not alter vascular or cardiac function/morphology.
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Affiliation(s)
- Fernando A C Seara
- Department of Physiological Sciences, Institute of Biological and Health Sciences, Federal Rural University of Rio de Janeiro, Brazil; Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Brazil.
| | - Pedro P Pereira-Junior
- Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Brazil
| | - Claudio Silva-Almeida
- Department of Physiological Sciences, Institute of Biological and Health Sciences, Federal Rural University of Rio de Janeiro, Brazil; Estácio de Sá University, Brazil
| | - Raoni C Dos-Santos
- Department of Physiological Sciences, Institute of Biological and Health Sciences, Federal Rural University of Rio de Janeiro, Brazil
| | - Raquel N Souza
- Department of Physiological Sciences, Institute of Biological and Health Sciences, Federal Rural University of Rio de Janeiro, Brazil
| | - César R M Costa
- Department of Physiological Sciences, Institute of Biological and Health Sciences, Federal Rural University of Rio de Janeiro, Brazil; Multicenter Postgraduate Program of Physiological Sciences, Brazilian Society of Physiology, Brazil
| | - Ainá E Domingos
- Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Brazil
| | - Raiana A Q Barbosa
- Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Brazil
| | - Ana P Ferraz
- Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Brazil
| | - André A N Machado
- Laboratory of Biochemistry and Gene Expression, University of Ceará, Brazil
| | - Vânia M Ceccato
- Laboratory of Biochemistry and Gene Expression, University of Ceará, Brazil
| | - Christina M Takiya
- Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Brazil
| | - Cristiano G Ponte
- Federal Institute of Education, Science, and Technology of Rio de Janeiro, Brazil
| | - Luis C Reis
- Department of Physiological Sciences, Institute of Biological and Health Sciences, Federal Rural University of Rio de Janeiro, Brazil; Multicenter Postgraduate Program of Physiological Sciences, Brazilian Society of Physiology, Brazil
| | - Emerson L Olivares
- Department of Physiological Sciences, Institute of Biological and Health Sciences, Federal Rural University of Rio de Janeiro, Brazil; Multicenter Postgraduate Program of Physiological Sciences, Brazilian Society of Physiology, Brazil
| | - Jose H M Nascimento
- Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Brazil
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Demoulin R, Poyet R, Capilla E, Tortat AV, Pons F, Brocq FX, Druelle A, Jego C, Foucault G, Cellarier GR. [Cardiovascular complications of doping products]. Ann Cardiol Angeiol (Paris) 2018; 67:365-369. [PMID: 30290907 DOI: 10.1016/j.ancard.2018.08.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 08/29/2018] [Indexed: 01/04/2023]
Abstract
Doping is the use of a substance that artificially increases an individual's physical ability for competition purpose. Products and methods used in doping are not without risk, especially at cardiovascular level. Here we review the most common doping substances in sport and their cardiovascular consequences.
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Affiliation(s)
- R Demoulin
- Service de cardiologie et maladies vasculaires, hôpital d'instruction des armées Sainte-Anne, boulevard Sainte-Anne, BP 600, 83800 Toulon cedex 9, France.
| | - R Poyet
- Service de cardiologie et maladies vasculaires, hôpital d'instruction des armées Sainte-Anne, boulevard Sainte-Anne, BP 600, 83800 Toulon cedex 9, France
| | - E Capilla
- Service de cardiologie et maladies vasculaires, hôpital d'instruction des armées Sainte-Anne, boulevard Sainte-Anne, BP 600, 83800 Toulon cedex 9, France
| | - A V Tortat
- Service de cardiologie et maladies vasculaires, hôpital d'instruction des armées Sainte-Anne, boulevard Sainte-Anne, BP 600, 83800 Toulon cedex 9, France
| | - F Pons
- Service de cardiologie et maladies vasculaires, hôpital d'instruction des armées Sainte-Anne, boulevard Sainte-Anne, BP 600, 83800 Toulon cedex 9, France
| | - F-X Brocq
- Centre d'expertise médicale du personnel navigant, hôpital d'instruction des armées Sainte-Anne, boulevard Sainte-Anne, BP 600, 83800 Toulon cedex 9, France
| | - A Druelle
- Service de médecine hyperbare et expertise de la plongée, hôpital d'instruction des armées Sainte-Anne, boulevard Sainte-Anne, BP 600, 83800 Toulon cedex 9, France
| | - C Jego
- Service de cardiologie et maladies vasculaires, hôpital d'instruction des armées Sainte-Anne, boulevard Sainte-Anne, BP 600, 83800 Toulon cedex 9, France
| | - G Foucault
- Service de cardiologie et maladies vasculaires, hôpital d'instruction des armées Sainte-Anne, boulevard Sainte-Anne, BP 600, 83800 Toulon cedex 9, France
| | - G-R Cellarier
- Service de cardiologie et maladies vasculaires, hôpital d'instruction des armées Sainte-Anne, boulevard Sainte-Anne, BP 600, 83800 Toulon cedex 9, France
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3
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Affiliation(s)
- Jim McVeigh
- Public Health Institute, Liverpool John Moores University, Liverpool, UK
| | - Emma Begley
- Public Health Institute, Liverpool John Moores University, Liverpool, UK
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4
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Mullen JE, Gårevik N, Schulze JJ, Rane A, Björkhem Bergman L, Ekström L. Perturbation of the Hematopoietic Profile by Anabolic Androgenic Steroids. ACTA ACUST UNITED AC 2014; 2014:1-7. [DOI: 10.1155/2014/510257] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective. The aim of this study was to investigate the hematopoietic profile in AAS abusers, during or short after their last abuse and approximately six months later. Moreover, we studied if supraphysiological doses of testosterone influence the concentration of hemoglobin and erythropoietin in healthy volunteers. Design and Methods. Subjects (N=31) were recruited through an antidoping hotline. The hematological profile was measured when the subjects entered the study and approximately 6 months later. Testosterone enanthate (500 mg) was administered to healthy volunteers (N=24). Gene expression was studied in human hek293 cells exposed to 1 μM testosterone. Results. Decreased levels of hemoglobin, erythrocyte volume fraction, and erythrocyte counts were observed after 6 months without the use of AAS. Results in volunteers show that hemoglobin increased 3% four and 15 days after testosterone administration, whereas EPO was significantly increased by 38% four days after dose. Agreeingly, in vitro study shows that testosterone induces the mRNA level of EPO with 65% after 24-hour exposure. Conclusion. These results indicate that supraphysiological doses of testosterone may cause a perturbation in the hematopoietic profile. This is of interest in relation to the adverse cardiovascular effects observed in AAS abusers.
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Germanakis I, Tsarouhas K, Fragkiadaki P, Tsitsimpikou C, Goutzourelas N, Champsas MC, Stagos D, Rentoukas E, Tsatsakis AM. Oxidative stress and myocardial dysfunction in young rabbits after short term anabolic steroids administration. Food Chem Toxicol 2013; 61:101-5. [DOI: 10.1016/j.fct.2013.03.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 03/16/2013] [Indexed: 01/01/2023]
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Skogastierna C, Hotzen M, Rane A, Ekström L. A supraphysiological dose of testosterone induces nitric oxide production and oxidative stress. Eur J Prev Cardiol 2013; 21:1049-54. [DOI: 10.1177/2047487313481755] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Accepted: 02/18/2013] [Indexed: 11/17/2022]
Affiliation(s)
- Cristine Skogastierna
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Maja Hotzen
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anders Rane
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lena Ekström
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
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Hajimoradi B, Kazerani H. Echocardiographic findings in power athletes abusing anabolic androgenic steroids. Asian J Sports Med 2013; 4:10-4. [PMID: 23785570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2012] [Accepted: 06/10/2012] [Indexed: 11/05/2022] Open
Abstract
PURPOSE Anabolic androgenic steroids (AAS) abuse for improving physical appearance and performance in body builders is common and has been considered responsible for serious cardiovascular effects. Due to disagreement about cardiovascular side effects of these drugs in published articles, this case control study was designed to evaluate the echocardiographic findings in body builder athletes who are current and chronic abusers of these drugs. METHODS Body builder athletes with continuous practice for the preceding two years and were training at least twice weekly were selected and divided into AAS abuser and non user and compared with age and BMI matched non athletic healthy volunteers (15 cases in each group). RESULTS There was no significant difference in left ventricular size or function either systolic or diastolic in comparison to cases and control groups. The only difference was in diastolic size of septum and free wall but observed differences were only significant (P = 0.05) between first (athletic with AAS abuser) and third group (non athletic and nonuser). The difference between the above-mentioned indexes were not significant between two groups of athletes. CONCLUSION Observed differences in diastolic size of septum and free wall is in favor of that long term abuse of anabolic steroid results in accentuation of physiologic hypertrophy due to long term sport most probably due to higher rate pressure product. Furthermore long term abuse and supra pharmacologic doses do not have significant effect in size and left ventricular function.
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Abstract
Abuse of anabolic androgenic steroids (AAS) has been linked to a variety of different cardiovascular side effects. In case reports, acute myocardial infarction is the most common event presented, but other adverse cardiovascular effects such as left ventricular hypertrophy, reduced left ventricular function, arterial thrombosis, pulmonary embolism and several cases of sudden cardiac death have also been reported. However, to date there are no prospective, randomized, interventional studies on the long-term cardiovascular effects of abuse of AAS. In this review we have studied the relevant literature regarding several risk factors for cardiovascular disease where the effects of AAS have been scrutinized:(1) Echocardiographic studies show that supraphysiologic doses of AAS lead to both morphologic and functional changes of the heart. These include a tendency to produce myocardial hypertrophy (Fig. 3), a possible increase of heart chamber diameters, unequivocal alterations of diastolic function and ventricular relaxation, and most likely a subclinically compromised left ventricular contractile function. (2) AAS induce a mild, but transient increase of blood pressure. However, the clinical significance of this effect remains modest. (3) Furthermore, AAS confer an enhanced pro-thrombotic state, most prominently through an activation of platelet aggregability. The concomitant effects on the humoral coagulation cascade are more complex and include activation of both pro-coagulatory and fibrinolytic pathways. (4) Users of AAS often demonstrate unfavorable measurements of vascular reactivity involving endothelial-dependent or endothelial-independent vasodilatation. A degree of reversibility seems to be consistent, though. (5) There is a comprehensive body of evidence documenting that AAS induce various alterations of lipid metabolism. The most prominent changes are concomitant elevations of LDL and decreases of HDL, effects that increase the risk of coronary artery disease. And finally, (6) the use of AAS appears to confer an increased risk of life-threatening arrhythmia leading to sudden death, although the underlying mechanisms are still far from being elucidated. Taken together, various lines of evidence involving a variety of pathophysiologic mechanisms suggest an increased risk for cardiovascular disease in users of anabolic androgenic steroids.
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Affiliation(s)
- Paul Vanberg
- Chief Physician/Senior Cardiologist, Oslo University Hospital - Aker, Trondheimsveien 235, 0514-Oslo University Hospital, Oslo, Norway.
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9
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Abstract
Side effects of anabolic steroids with relevance in forensic medicine are mainly due to life-threatening health risks with potential fatal outcome and cases of uncertain limitations of criminal liability after steroid administration. Both problems are typically associated with long-term abuse and excessive overdose of anabolic steroids. Side effects may be due to direct genomic or nongenomic activities (myotrophic, hepatotoxic), can result from down-regulation of endogenous biosynthesis (antiandrogenic) or be indirect consequence of steroid biotransformation (estrogenic).Logically, there are no systematic clinical studies available and the number of causally determined fatalities is fairly limited. The following compilation reviews typical abundant observations in cases where nonnatural deaths (mostly liver failure and sudden cardiac death) were concurrent with steroid abuse. Moreover, frequent associations between structural characteristics and typical side effects are summarized.
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Affiliation(s)
- Andreas Büttner
- Institute of Legal Medicine, St.-Georg-Str. 108, 18055, Rostock, Germany
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10
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Abstract
The "win at all costs" mentality fuels athletes to seek performance-enhancing substances, such as anabolic-androgenic steroids, to gain an advantage over their opponents. Nonathletes espouse this same attitude to "win" the battle of attractiveness. An enhanced understanding of anabolic-androgenic steroids and the motivations behind their abuse will arm pediatricians with the ability to engage their patients in a balanced discussion of the benefits and costly risks of anabolic-androgenic steroids and successfully deter further use.
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Affiliation(s)
- Julie M Kerr
- Northeastern Ohio Universities College of Medicine, 4209 State Route 44, PO Box 95, Rootstown, OH 44272, USA.
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Beutel A, Bergamaschi CT, Campos RR. Effects of chronic anabolic steroid treatment on tonic and reflex cardiovascular control in male rats. J Steroid Biochem Mol Biol 2005; 93:43-8. [PMID: 15748831 DOI: 10.1016/j.jsbmb.2004.11.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2004] [Accepted: 11/22/2004] [Indexed: 10/25/2022]
Abstract
The aim of this study was to analyze the cardiovascular effects of chronic stanozolol administration in male rats. The rats were randomly assigned to one of three groups: (1) control (n=12), (2) chronic treatment with low dose of stanozolol (LD, n=18, 5 mg/kgweek) and; (3) treatment with high dose of stanozolol (HD, n=28, 20 mg/kgweek). Mean arterial pressure (MAP) was higher in both HD (128+/-2.2 mmHg) and LD (126+/-2.5 mmHg) than control (116+/-2 mmHg). The LD group showed an increase in cardiac output (control 121+/-2.5, LD 154+/-5.9 ml/min), whereas in the HD group total peripheral resistance increased (control 1.03+/-0.07, HD 1.26+/-0.07 mmHg/ml/min). Acute sympathetic blockade caused a similar decrease in MAP in all groups. In conscious rats, the baroreflex index for bradycardia (control -3.7+/-0.4, LD -2.0+/-0.1 beat/mmHg) and tachycardia (control -3.6+/-0.3, LD -4.7+/-0.2 beat/mmHg) responses changed only in the LD group. Cardiac hypertrophy was observed in both treated groups (P<0.05). In conclusion, hypertension with differential hemodynamic changes and alterations in the reflex control in heart rate is seen at different stanozolol doses, which may be important variables in the cardiovascular effects of anabolic steroids.
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Affiliation(s)
- Abram Beutel
- Department of Physiology, Federal University of São Paulo, Paulista School of Medicine, São Paulo, SP, Brazil
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13
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Abstract
Androgenic-anabolic steroids (AAS) are synthetic derivatives of the male hormone testosterone. They can exert strong effects on the human body that may be beneficial for athletic performance. A review of the literature revealed that most laboratory studies did not investigate the actual doses of AAS currently abused in the field. Therefore, those studies may not reflect the actual (adverse) effects of steroids. The available scientific literature describes that short-term administration of these drugs by athletes can increase strength and bodyweight. Strength gains of about 5-20% of the initial strength and increments of 2-5 kg bodyweight, that may be attributed to an increase of the lean body mass, have been observed. A reduction of fat mass does not seem to occur. Although AAS administration may affect erythropoiesis and blood haemoglobin concentrations, no effect on endurance performance was observed. Little data about the effects of AAS on metabolic responses during exercise training and recovery are available and, therefore, do not allow firm conclusions. The main untoward effects of short- and long-term AAS abuse that male athletes most often self-report are an increase in sexual drive, the occurrence of acne vulgaris, increased body hair and increment of aggressive behaviour. AAS administration will disturb the regular endogenous production of testosterone and gonadotrophins that may persist for months after drug withdrawal. Cardiovascular risk factors may undergo deleterious alterations, including elevation of blood pressure and depression of serum high-density lipoprotein (HDL)-, HDL2- and HDL3-cholesterol levels. In echocardiographic studies in male athletes, AAS did not seem to affect cardiac structure and function, although in animal studies these drugs have been observed to exert hazardous effects on heart structure and function. In studies of athletes, AAS were not found to damage the liver. Psyche and behaviour seem to be strongly affected by AAS. Generally, AAS seem to induce increments of aggression and hostility. Mood disturbances (e.g. depression, [hypo-]mania, psychotic features) are likely to be dose and drug dependent. AAS dependence or withdrawal effects (such as depression) seem to occur only in a small number of AAS users. Dissatisfaction with the body and low self-esteem may lead to the so-called 'reverse anorexia syndrome' that predisposes to the start of AAS use. Many other adverse effects have been associated with AAS misuse, including disturbance of endocrine and immune function, alterations of sebaceous system and skin, changes of haemostatic system and urogenital tract. One has to keep in mind that the scientific data may underestimate the actual untoward effects because of the relatively low doses administered in those studies, since they do not approximate doses used by illicit steroid users. The mechanism of action of AAS may differ between compounds because of variations in the steroid molecule and affinity to androgen receptors. Several pathways of action have been recognised. The enzyme 5-alpha-reductase seems to play an important role by converting AAS into dihydrotestosterone (androstanolone) that acts in the cell nucleus of target organs, such as male accessory glands, skin and prostate. Other mechanisms comprises mediation by the enzyme aromatase that converts AAS in female sex hormones (estradiol and estrone), antagonistic action to estrogens and a competitive antagonism to the glucocorticoid receptors. Furthermore, AAS stimulate erythropoietin synthesis and red cell production as well as bone formation but counteract bone breakdown. The effects on the cardiovascular system are proposed to be mediated by the occurrence of AAS-induced atherosclerosis (due to unfavourable influence on serum lipids and lipoproteins), thrombosis, vasospasm or direct injury to vessel walls, or may be ascribed to a combination of the different mechanisms. AAS-induced increment of muscle tissue can be attributed to hypertrophy and the formation of new muscle fibres, in which key roles are played by satellite cell number and ultrastructure, androgen receptors and myonuclei.
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Affiliation(s)
- Fred Hartgens
- Department of Surgery, Outpatient Clinic Sports Medicine, University Hospital Maastricht, and Sports Medicine Center Maastricht, Maastricht, The Netherlands.
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14
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Abstract
Despite reports of an increase in the incidence of simultaneous cocaine and anabolic steroid abuse, potential adverse interactions between these two drugs on the cardiovascular system are largely unquantified. Cocaine has been reported to induce coronary vasoconstriction, cardiac arrhythmias and conduction delays. Anabolic steroids have been associated with cardiac hypertrophy and hypertension. Utilising both in vivo (radiotelemetry) and in vitro (isolated Langendorff-perfused heart) techniques, our aim was to determine whether anabolic steroids cause cardiac hypertrophy and alter cardiac function, and consequently alter the response of the heart to cocaine. It was found that 15 days of treatment of rats with nandrolone decanoate (20 mg/kg, s.c.) was not sufficient to cause hypertrophy, alter cardiac function or the spread of electrical activity through the heart. However, nandrolone pretreatment was found to significantly potentiate the heart rate response to cocaine (45 mg/kg, i.p.) in vivo. This study indicates that nandrolone significantly elevates the heart rate response to high dose cocaine without changing heart morphology. The mechanism of this interaction remains uncertain.
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Affiliation(s)
- B D Phillis
- Department of Clinical and Experimental Pharmacology, University of Adelaide, Frome Road, 5000, Adelaide, Australia
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15
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Abstract
A young male bodybuilder, consuming large doses of anabolic steroids (AS), presented to the Emergency Department (ED) with symptomatic rapid atrial fibrillation (AF). Echocardiogram revealed significant septal hypokinesis, and posterior and septal wall thickness at the upper limit of normal for highly trained athletes. The atrial fibrillation had not recurred at 10 weeks after discontinuation of AS use. Consumption of these agents in athletes has been associated with hypertension, ischemic heart disease, hypertrophic cardiomyopathy, and sudden death.
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Affiliation(s)
- M L Sullivan
- Department of Emergency Medicine, Jacobi Medical Center, Bronx, New York, USA
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16
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Abstract
Anabolic steroids are synthetic derivatives of testosterone that were developed as adjunct therapy for a variety of medical conditions. Today they are most commonly used to enhance athletic performance and muscular development. Both illicit and medically indicated anabolic steroid use have been temporally associated with many subsequent defects within each of the body systems. Testosterone is the preferred ligand of the human androgen receptor in the myocardium and directly modulates transcription, translation, and enzyme function. Consequent alterations of cellular pathology and organ physiology are similar to those seen with heart failure and cardiomyopathy. Hypertension, ventricular remodeling, myocardial ischemia, and sudden cardiac death have each been temporally and causally associated with anabolic steroid use in humans. These effects persist long after use has been discontinued and have significant impact on subsequent morbidity and mortality. The mechanisms of cardiac disease as a result of anabolic steroid use are discussed in this review.
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Abstract
As a result of a number of factors, there is tremendous diversity in the pattern of cardiac mechanics encountered in athletes. Nevertheless, several trends can be identified, and several conclusions are possible. Hypertrophy of a mild to moderate degree and out of proportion to body size is a common finding. Some athletes experience ventricular dilation with appropriate hypertrophy and preservation of the ventricular mass-to-volume ratio, whereas others manifest concentric hypertrophy with an increased mass-to-volume ratio. The functional changes that are encountered appear to be secondary to the structural alterations, and there is no evidence of altered myocardial systolic or diastolic properties. Some athletes with hypertrophy have reduced wall stress when they are evaluated at rest, and velocity of shortening is augmented because of the reduced afterload. As a result of adaptation to a high-output state, some athletes appear preload reduced when evaluated at rest. Although velocity of shortening is not affected by preload status, fractional shortening is inversely related to preload. The magnitude of systolic shortening is therefore the net result of altered preload and afterload and cannot be understood without assessing both of these parameters. When the various determinants of systolic shortening are included, contractility appears to be normal. There have been several reports of depressed contractility immediately after extreme exertion. Although the mechanism remains uncertain, several intriguing possibilities have been proposed.
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Affiliation(s)
- S D Colan
- Department of Cardiology, Children's Hospital, Boston, Massachusetts, USA
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20
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Abstract
OBJECTIVE To summarize the literature describing the epidemiology, pharmacology, efficacy, and adverse effects associated with androgenic-anabolic steroid (AAS) use among athletes. DATA SOURCES Relevant articles were identified from a MEDLINE search using the search terms "Doping in Sports," "Anabolic Steroids (exploded)," and "Androgens (exploded)." Additional references were found in the bibliographies of these articles. STUDY SELECTION/DATA EXTRACTION We reviewed studies of AAS use among professional athletes. Interpretation of these studies is difficult because of poor research design. The efficacy studies lacked adequate placebo control. Much of the literature describing adverse effects consists of anecdotal reports. All of this literature was considered for review. DATA SYNTHESIS Of all ergogenic drugs, AASs are the most widely abused. Abuse of AASs among high school students is estimated at five to ten percent. AASs are hypothesized to produce ergogenic effects during periods of concomitant positive nitrogen balance via antagonism of the catabolic effect of glucocorticoids released during intense exercise. Despite years of study, the extent of the ergogenic effects associated with AASs remains unclear. This may be because most studies have failed to approximate athletes' AAS usage patterns. The primary toxic effects of AASs are divided into four areas: hepatic, reproductive, cardiovascular, and psychiatric. Athletes do not consider these effects severe enough to refrain from using these drugs. CONCLUSIONS Athletes view AASs as an essential component for success. Without adequate intervention measures, AAS abuse is likely to continue unchecked.
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Affiliation(s)
- D A Smith
- Division of Clinical Pharmacy, College of Pharmacy, University of Iowa, Iowa City 52242
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Brower KJ, Catlin DH, Blow FC, Eliopulos GA, Beresford TP. Clinical assessment and urine testing for anabolic-androgenic steroid abuse and dependence. Am J Drug Alcohol Abuse 1991; 17:161-71. [PMID: 1862790 DOI: 10.3109/00952999108992819] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The emerging epidemic of anabolic-androgenic steroid use, no longer confined to elite athletes, is associated with adverse health consequences for which users may seek treatment. As with other forms of drug abuse, patients may deny or hide their use of steroids while seeking treatment for bothersome side effects or other problems. Thus, clinicians may increasingly, but unknowingly, see patients who are using steroids. Early detection and treatment of steroid abuse and dependence is critical in order to prevent serious and potentially fatal consequences. Therefore, it is incumbent upon clinicians to know the signs and symptoms of using steroids, and to be familiar with the clinical indications for urine testing. Using case examples, the authors review the assessment of steroid abuse and dependence in clinical practice and illustrate the role of urine testing in the assessment process.
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Affiliation(s)
- K J Brower
- University of Michigan Alcohol Research Center, Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor 48109
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23
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Abstract
The use of anabolic-androgenic steroids is epidemic in the sporting world, and the recent recognition of their pervasive use by recreational and adolescent athletes has made the abuse of these drugs a public health concern. A critical review of the literature supports the doctrine that anabolic-androgenic steroids can improve muscular performance if certain criteria are met, but some of the health risks associated with their use may be irreversible, and life-threatening. Furthermore, polydrug abuse, restrictive diets, and dehydrating practices may potentiate the health risks associated with weight training and steroid use. Recent investigations of nutritional and training alternatives to anabolic-androgenic steroids are promising. To help lure athletes from drug abuse, the pursuit of new areas of research and education should be priorities in the campaign against the abuse of anabolic steroids.
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Affiliation(s)
- S M Kleiner
- Sarah W. Stedman Center for Nutritional Studies, Duke University Medical Center, Durham, North Carolina
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Abstract
Anabolic steroids are extensively abused as ergogenic aids by athletes (and others). A number of features of anabolic steroid use and toxicology have been recently reviewed in the Journal, and a large body of data has accumulated concerning their toxic nature. The lipoprotein profile induced by anabolic steroids carries a markedly adverse cardiovascular risk. Glucose metabolism is significantly altered and includes peripheral insulin resistance, hyperinsulinaemia and attenuated responses to glucagon. Hypertension has been noted. Psychiatric and psychological alterations are major toxicities of anabolic steroids, and probably constitute the major mechanism of their action. Hepatic neoplasia occurs in the setting of abuse of this class of drugs, and may be related to their use, although there is no convincing evidence that other malignancies are induced in athletes who abuse them. Gross disturbance of reproductive function occurs in both sexes: hypogonadal states are common and prolonged. The anabolic steroids are toxic drugs with both long and short term effects. Their abuse by athletes is to be decried, particularly in view of the frequent and prolonged use by the young.
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Affiliation(s)
- S Graham
- Concord Repatriation Hospital, NSW, Australia
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25
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Narducci WA, Wagner JC, Hendrickson TP, Jeffrey TP. Anabolic steroids--a review of the clinical toxicology and diagnostic screening. J Toxicol Clin Toxicol 1990; 28:287-310. [PMID: 2231829 DOI: 10.3109/15563659008994431] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Anabolic steroids have been used by athletes since the 1950s to increase size and strength in order to improve their performance. The abuse of these substances has since expanded to include junior high and high school male and female athletes and non-athletes. The anabolic and androgenic effects of these agents, when taken in the doses needed to produce increases in size and strength, result in significant serious adverse effects involving the skin, liver, cardiovascular, musculoskeletal, endocrine and reproductive systems. Some of these effects are irreversible. It is essential that clinical toxicologists, emergency room physicians and psychiatrists are familiar with the physical and psychological effects, as well as the changes in laboratory parameters, that typically occur from chronic use of anabolic steroids. The toxicities and representative clinical profiles of steroid users are presented, and the methods available for diagnostic screening using psychological testing and urine analysis are also reviewed.
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Affiliation(s)
- W A Narducci
- Department of Pharmacy Practice, University of Nebraska Medical Center, Omaha
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26
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Abstract
Anabolic steroids are used therapeutically for various disorders and as ergogenic aids by athletes to augment strength, muscular development, and to enhance performance. There is a wide range of concomitant temporary and permanent adverse effects with steroid administration. Several well-documented adverse actions of these hormones may develop rapidly within several weeks or less (i.e. altered reproductive function) or require up to several years of steroid intake (i.e. liver carcinoma). More recent studies indicate that glucose intolerance, insulin resistance, increased cardiovascular disease risk profiles, cerebral dangers, musculoskeletal injuries, prostate cancer, psychosis and schizophrenic episodes, among others, accompany anabolic steroid intake. There is, at present, no evidence to support the claim that athletes are less susceptible to adverse effects than those individuals receiving hormone treatment in a clinical setting. Based on the available information which has accumulated primarily from cross-sectional, short term longitudinal, and case studies, there is a need: (a) to develop a comprehensive battery of specific and sensitive markers of adverse effects, particularly those that would be able to detect the onset of adverse actions; and (b) to conduct controlled long term longitudinal studies in order to fully understand the extensiveness and mechanisms involved in the occurrence of adverse effects.
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Affiliation(s)
- R C Hickson
- Department of Physical Education, University of Illinois, Chicago
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