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Fyksen TS, Seljeflot I, Vanberg P, Atar D, Halvorsen S. Platelet activity, coagulation, and fibrinolysis in long-term users of anabolic-androgenic steroids compared to strength-trained athletes. Thromb Res 2024; 238:60-66. [PMID: 38676967 DOI: 10.1016/j.thromres.2024.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 04/18/2024] [Accepted: 04/23/2024] [Indexed: 04/29/2024]
Abstract
INTRODUCTION Use of anabolic-androgenic steroids (AAS) is associated with adverse cardiovascular (CV) effects, including potential prothrombotic effects. This study aimed to assess platelet activation and aggregation, coagulation, and fibrinolysis, in long-term AAS users compared to non-using strength-trained athletes. MATERIALS AND METHODS Thirty-seven strength-trained men using AAS were compared to seventeen non-using professional strength-trained athletes at similar age (median 33 years). AAS use was verified by blood and urine analyses. Platelet Function Analyzer 100 (PFA-100) and whole blood impedance aggregometry with thrombin, arachidonic acid, and ADP as agonists, were performed to evaluate platelet aggregation. ELISA methods were used for markers of platelet activation. Fibrinogen, D-dimer, the coagulation inhibitors protein S and C activity, and antithrombin were measured by routine. Fibrinolysis was evaluated by Plasminogen Activator Inhibitor-1 (PAI-1) activity. RESULTS There were no significant differences in platelet aggregation between the two groups. Von Willebrand factor was lower among the AAS users (p < 0.01), and P-Selectin was slightly higher (p = 0.05), whereas CD40 Ligand, β-thromboglobulin, and thrombospondin did not differ significantly. No differences were found in the assessed coagulation inhibitors. Higher D-dimer levels (p < 0.01) and lower PAI-1 activity (p < 0.01) were found among the AAS users. CONCLUSIONS The investigated long-term users of AAS did not exhibit elevated platelet activity compared to strength-trained non-using athletes. However, AAS use was associated with higher D-dimer levels and lower PAI-1 activity. These findings suggest that any prothrombotic effect of long-term AAS use may predominantly involve other aspects of the hemostatic system than blood platelets.
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Affiliation(s)
- Tea Sætereng Fyksen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway.
| | - Ingebjørg Seljeflot
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway
| | - Paul Vanberg
- Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway
| | - Dan Atar
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway
| | - Sigrun Halvorsen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway
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Fyksen TS, Vanberg P, Gjesdal K, von Lueder TG, Bjørnerheim R, Steine K, Atar D, Halvorsen S. Cardiovascular phenotype of long-term anabolic-androgenic steroid abusers compared with strength-trained athletes. Scand J Med Sci Sports 2022; 32:1170-1181. [PMID: 35460300 PMCID: PMC9540672 DOI: 10.1111/sms.14172] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 04/12/2022] [Accepted: 04/18/2022] [Indexed: 12/04/2022]
Abstract
Introduction Abuse of anabolic‐androgenic steroids (AAS) has been linked to a variety of different cardiovascular (CV) side effects, but still the clinical effects of AAS abuse on CV risk are not clear. The aim of this study was to assess the CV phenotype of a large cohort of men with long‐term AAS use compared with strength‐trained athletes without AAS use. Methods Fifty one strength‐trained men with ≥3 years of AAS use was compared with twenty one strength‐trained competing athletes. We verified substance abuse and non‐abuse by blood and urine analyses. The participants underwent comprehensive CV evaluation including laboratory analyses, 12‐lead ECG with measurement of QT dispersion, exercise ECG, 24 h ECG with analyses of heart rate variability, signal averaged ECG, basic transthoracic echocardiography, and coronary computed tomography angiography (CCTA). Results Hemoglobin levels and hematocrit were higher among the AAS users compared with non‐users (16.8 vs. 15.0 g/dl, and 0.50% vs. 0.44%, respectively, both p < 0.01) and HDL cholesterol significantly lower (0.69 vs. 1.25 mmol/L, p < 0.01). Maximal exercise capacity was 270 and 280 W in the AAS and the non‐user group, respectively (p = 0.04). Echocardiography showed thicker intraventricular septum and left ventricular (LV) posterior wall among AAS users (p < 0.01 for both), while LV ejection fraction was lower (50 vs. 54%, p = 0.02). Seven AAS users (17%) had evidence of coronary artery disease on CCTA. There were no differences in ECG measures between the groups. Conclusions A divergent CV phenotype dominated by increased CV risk, accelerated coronary artery disease, and concentric myocardial hypertrophy was revealed among the AAS users.
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Affiliation(s)
- Tea Saetereng Fyksen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway
| | - Paul Vanberg
- Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway
| | - Knut Gjesdal
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway
| | | | - Reidar Bjørnerheim
- Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway
| | - Kjetil Steine
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Cardiology, Akershus University Hospital, Lørenskog, Norway
| | - Dan Atar
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway
| | - Sigrun Halvorsen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway
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Saetereng T, Vanberg P, Steine K, Atar D, Halvorsen S. Cardiovascular risk associated with long-term anabolic-androgenic steroid abuse: an observational study from Norway. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The use of anabolic-androgenic steroids (AAS) has become highly prevalent among recreational weightlifters. Numerous case reports have suggested an association between AAS use and a vast range of different cardiovascular diseases, including sudden cardiac death (SCD) and coronary artery disease (CAD). Few clinical studies have evaluated the risk of SCD and the prevalence of CAD in individuals with long-term AAS use.
Purpose
To evaluate the risk of ventricular arrhythmias and the prevalence of CAD among men with long-term AAS use.
Methods
Strength-trained men with at least three years of cumulative AAS use were recruited from recreational gyms. The control group consisted of strength-trained competing athletes who self-reported never using any performance enhancing drugs (non-users). AAS use was verified by sophisticated blood and urine analyses. Study participants went through a comprehensive cardiovascular evaluation including exercise ECG, 24 h ECG, heart rate variability (HRV) measures, signal averaged ECG (SAECG) and QT dispersion (QTd). Coronary computed tomography angiography (CCTA) was performed in AAS users. Not all participants had all tests.
Results
We included 51 AAS users and 21 non-users. Median age (25th-75th percentile) was 33 (29–37) years in the user group and 33 (29–42) years in the non-user group. Forty-eight (94%) of the users had been using AAS for five years or more. Characteristics are presented in the table. AAS users had significantly lower HDL values compared to non-users (p<0.001). No signs of ischemia or arrhythmias were detected during exercise ECG, however maximal exercise capacity was lower than in the control group and also compared to age-standardized values. A considerable, but statistically non-significant reduction was seen in overall HRV estimated as the standard deviation of the RR intervals for normal sinus beats (SDNN) (p=0.05). No difference was seen regarding left ventricular late potentials or QTd (table). Eight (19%) of the forty-two AAS users undergoing CCTA had at least a mild degree of CAD, and four of them three-vessel disease.
Conclusion
No ECG-findings indicated an increased risk of ventricular arrhythmias among the long-term AAS users. However, their maximal exercise capacity was lower than in controls, and one fifth of the long-term AAS users had verified CAD on CT coronary angiography.
Funding Acknowledgement
Type of funding sources: None. Table 1
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Affiliation(s)
| | - P Vanberg
- Oslo University Hospital Ulleval, Department of Cardiology, Oslo, Norway
| | - K Steine
- Akershus University Hospital, Department of Cardiology, Oslo, Norway
| | - D Atar
- Oslo University Hospital Ulleval, Department of Cardiology, Oslo, Norway
| | - S Halvorsen
- Oslo University Hospital Ulleval, Department of Cardiology, Oslo, Norway
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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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Tveit A, Grundtvig M, Gundersen T, Vanberg P, Semb AG, Holt E, Gullestad L. Analysis of pravastatin to prevent recurrence of atrial fibrillation after electrical cardioversion. Am J Cardiol 2004; 93:780-2. [PMID: 15019894 DOI: 10.1016/j.amjcard.2003.12.009] [Citation(s) in RCA: 97] [Impact Index Per Article: 4.9] [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: 09/30/2003] [Revised: 12/02/2003] [Accepted: 12/02/2003] [Indexed: 10/26/2022]
Abstract
To test the hypothesis that a statin could reduce the recurrence rate of atrial fibrillation after electrical cardioversion (EC), we performed an open, controlled multicenter study. Patients (n = 114) who had atrial fibrillation >48 hours and who were scheduled for EC were randomized to receive 40 mg of pravastatin once daily for 3 weeks before and 6 weeks after EC or no drug in addition to standard therapy. Pravastatin did not reduce the recurrence rate of atrial fibrillation after EC.
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Affiliation(s)
- Arnljot Tveit
- Department of Internal Medicine, Asker & Baerum Hospital, Rud, Norway.
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Abstract
Magnesium has previously been used in the treatment of various arrhythmias, but few randomized and prospective studies are available. In a single-blind study, the efficacy and safety of intravenous magnesium sulfate (bolus doses of 5 + 5 mmol followed by infusion of 0.04 mmol/min) versus verapamil (5 + 5 mg followed by 0.1 mg/min) was evaluated in 57 patients with supraventricular arrhythmias (supraventricular tachycardia, atrial fibrillation, and atrial flutter) of recent onset (less than 1 week). Fifteen (58%) of the patients receiving magnesium (n = 26) converted to sinus rhythm within 4 h, and 16 (62%) within 24 h. Verapamil caused a lower ventricular rate, but only six (19%) of the patients (n = 31) converted to sinus rhythm within 4 h (p < 0.01) and 16 (52%) within 24 h (NS). No side effects were observed during magnesium infusion, whereas six patients receiving verapamil had to be withdrawn from further study medication due to symptomatic side effects (hypotension in three, cardiac failure in three). Magnesium appears to be an effective and safe drug for the treatment of supraventricular arrhythmias. The overall efficacy for conversion to sinus rhythm is at least as effective as with verapamil, and its action is more rapid.
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Affiliation(s)
- L Gullestad
- Department of Internal Medicine, Baerum Hospital, Oslo, Norway
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