Blood Flow to Heart Stays Low Years After Steroid Cessation

TOPLINE:

Men who currently use or have a history of using anabolic androgenic steroids exhibit impaired myocardial flow reserve, indicating coronary microvascular dysfunction. This impairment appears to persist for years after the cessation of steroid use, with longer durations of use doubling the risk for reduced myocardial flow.

METHODOLOGY:

• Researchers conducted a cross-sectional study to assess myocardial flow reserve in men who were current or former users of anabolic androgenic steroids vs control individuals without any history of steroid use, using cardiac rubidium-82 (82Rb) PET-CT.
• They included 9src men (mean age, 35.1 years) involved in recreational strength training and without any established cardiovascular disease, of whom 32 and 31 were current and former users of anabolic steroids, respectively, and 27 reported never using steroids.
• Most participants (58.1%) who had used anabolic steroids in the past had ceased use for over a year before enrolling in the study.
• The participants underwent rest and adenosine stress cardiac PET-CT imaging using a 128-slice system, with 11srcsrc MBq 82Rb injections administered at a flow rate of 5src mL/min.
• The primary outcome measure was myocardial flow reserve, assessed by PET-CT, across the three groups. Analysis defined impaired myocardial microcirculation as a myocardial flow reserve <2.src and subclinically impaired microcirculation as a myocardial flow reserve <2.5.

TAKEAWAY:

• Mean myocardial flow reserve was lower in current (3.3 mL/g/min) and former users (3.3 mL/g/min) of steroids than in control individuals (3.7 mL/g/min); however, this difference was not statistically significant (P=.15).
• Impaired myocardial flow reserve was observed in 18.8% of current and 3.2% of former steroid users but was absent in control individuals (P=.src2), indicating persistent coronary microvascular dysfunction.
• Subclinically impaired myocardial flow reserve affected 28.1% of current users and 25.8% of former users, but only 3.7% of men who had not used steroids (P=.src2).
• Among former users, each doubling of the total duration of weekly use of steroids was independently associated with an increased risk for impaired myocardial flow reserve (odds ratio, 2.1; P=.src4).

IN PRACTICE:

“Our findings suggest that a proportion of younger men who use [steroids] risk development of coronary microvascular dysfunction at an early age and thus potentially carry an increased risk of cardiac disease, even years after” ceasing use of the substances, the authors of the study wrote.

SOURCE:

The study was led by Yeliz Bulut, MD, of Copenhagen University Hospital-Rigshospitalet, in Copenhagen, Denmark. It was published online on December 16, 2src24, in JAMA Network Open.

LIMITATIONS:

The main outcome, the difference in mean myocardial flow reserve between the groups, was not statistically significant. Even though the overall differences in impaired and subclinically impaired myocardial flow reserve were significant, post hoc pairwise comparisons did not reach statistical significance, possibly due to an inadequate sample size for multiple comparisons. The study relied on participants’ self-reported history of anabolic steroid use and did not account for unmeasured variables that could explain the observed association between anabolic steroid use and impaired myocardial flow reserve.

DISCLOSURES:

This study was supported by grants from the Novo Nordisk Foundation and the Health Research Foundation of the Capital Region in Denmark. Some authors reported receiving grants, personal fees, or lecture fees from the Novo Nordisk Foundation and other pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.