Lipid profile of body builders with and without self-administration of anabolic steroids

[Cardiovascular alterations associated with doping]

Doping -the abuse of anabolic-androgenic steroids in particular- is widespread in amateur and recreational sports and does not solely represent a problem of professional sports. Excessive overdose of anabolic steroids is well documented in bodybuilding or powerlifting leading to significant side effects. Cardiovascular damages are most relevant next to adverse endocrine effects.Clinical cases as well as forensic investigations of fatalities or steroid consumption in connection with trafficking of doping agents provide only anecdotal evidence of correlations between side effects and substance abuse. Analytical verification and self-declarations of steroid users have repeatedly confirmed the presumption of weekly dosages between 300 and 2000 mg, extra to the fact that co-administration of therapeutics to treat side-effects represent a routine procedure. Beside the most frequent use of medications used to treat erectile dysfunction or estrogenic side-effects, a substantial number of antihypertensive drugs of various classes, i.e. beta-blockers, diuretics, angiotensin II receptor antagonists, calcium channel blockers, as well as ACE inhibitors were recently confiscated in relevant doping cases. The presumptive correlation between misuse of anabolic steroids and self-treatment of cardiovascular side effects was explicitly confirmed by detailed user statements.Two representative fatalities of bodybuilders were introduced to outline characteristic, often lethal side effects of excessive steroid abuse. Moreover, illustrative autopsy findings of steroid acne, thrombotic occlusion of Ramus interventricularis anterior and signs of cardiac infarctions are presented.A potential steroid abuse should be carefully considered in cases of medical consultations of patients exhibiting apparent constitutional modifications and corresponding adverse effects. Moreover, common self-medications -as frequently applied by steroid consumers- should be taken into therapeutic considerations.

Cardiac and metabolic effects of anabolic-androgenic steroid abuse on lipids, blood pressure, left ventricular dimensions, and rhythm

Recent surveys and reports suggest that many athletes and bodybuilders abuse anabolic-androgenic steroids (AAS). However, scientific data on the cardiac and metabolic complications of AAS abuse are divergent and often conflicting. A total of 49 studies describing 1,467 athletes were reviewed to investigate the cardiovascular effects of the abuse of AAS. Although studies were typically small and retrospective, some associated AAS abuse with unfavorable effects. Otherwise healthy young athletes abusing AAS may show elevated levels of low-density lipoprotein and low levels of high-density lipoprotein. Although data are conflicting, AAS have also been linked with elevated systolic and diastolic blood pressure and with left ventricular hypertrophy that may persist after AAS cessation. Finally, in small case studies, AAS abuse has been linked with acute myocardial infarction and fatal ventricular arrhythmias. In conclusion, recognition of these adverse effects may improve the education of athletes and increase vigilance when evaluating young athletes with cardiovascular abnormalities.

Androgenic anabolic steroid abuse and the cardiovascular system

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.

Side effects of anabolic androgenic steroids: pathological findings and structure-activity relationships

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.

Global gene expression of fission yeast in response to cisplatin

The cellular response to the antitumor drug cisplatin is complex, and resistance is widespread. To gain insights into the global transcriptional response and mechanisms of resistance, we used microarrays to examine the fission yeast cell response to cisplatin. In two isogenic strains with differing drug sensitivity, cisplatin activated a stress response involving glutathione-S-transferase, heat shock, and recombinational repair genes. Genes required for proteasome-mediated protein degradation were up-regulated in the sensitive strain, whereas genes for DNA damage recognition/repair and for mitotic progression were induced in the resistant strain. The response to cisplatin overlaps in part with the responses to cadmium and the DNA-damaging agent methylmethane sulfonate. The different gene groups involved in the cellular response to cisplatin help the cells to tolerate and repair DNA damage and to overcome cell cycle blocks. These findings are discussed with respect to known cisplatin response pathways in human cells.

Reversibility of the effects on blood cells, lipids, liver function and hormones in former anabolic-androgenic steroid abusers

BACKGROUND

In contrast to the acute effects of anabolic-androgenic steroid (AAS) abuse, the long-term risk profile of former long-term abusers (ExA) is less clear.

METHODS

Blood parameters of 32 male bodybuilders and powerlifters were studied. Fifteen ExA had not been abusing AAS for at least 12-43 months on average (mean dosage 700 mg for 26 weeks per year over 9 years), 17 athletes (A) were still abusing AAS (750 mg for 33 weeks per 8 years).

FINDINGS

Hemoglobin (+5%), leucocytes (+33%) and platelets (+38%) were significantly higher in A. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were higher, cholinesterase activity (CHE) lower in A (65+/-55, 38+/-27 and 3719+/-1528U/l) compared to ExA (24+/-10, 18+/-11 and 6345+/-975U/l; each P<0.001) with normal values for gamma-glutamyl transpeptidase (gamma-GT) and bilirubin. ALT, AST and CHE correlated significantly with the extent (duration and weekly dosage, expressed as a point score) of AAS abuse in A (r=0.68, 0.57 and -0.62; each P<0.01). Total and LDL-cholesterol were similar, HDL-cholesterol was distinctly lower in A than in ExA (17+/-11 and 43+/-11 mg/dl; P<0.001) and correlated negatively with the extent of AAS abuse (r=-0.50; P<0.05). Testosterone and estradiol were significantly higher, while LH, FSH and the sexual-hormone-binding (SHB) protein were lower in A than in ExA (each P<0.001). Two ExA had testosterone levels below the normal range.

INTERPRETATION

The alterations in cell counts, HDL-cholesterol, liver function and most hormones of the pituitary-testicular axis induced by a long-term abuse of AAS were reversible after stopping the medication for over 1 year. In some ExA, an increased ALT activity and a depressed testosterone synthesis were found.

[43 cycles of anabolic steroid treatment studied in athletes: the uses and secondary effects]

OBJECTIVE

To know the actual abuse of anabolic steroids by amateur athletes in our environment as well as actions and secondary effects resulting from such abuse.

METHODS

Analytical observational study from May 1997 to November 1998. Forty-three therapy courses with anabolic steroids among 39 male athletes were studied. Diet and training were standardized for all participants. A verification was made that the test group started from a basal state.

RESULTS

Duration of therapy was 6 weeks and the mean total dose was 2,928 mg. Significant differences were found in the test group regarding basal and post-therapy values for: transaminases (AST: 29.8 vs 45.0 IU/l, p < 0.001. ALT: 32.9 vs 51.4 IU/l, p < 0.01), cholesterol, HDL-cholesterol (31.4 vs 19.7 mg/dl, p < 0.01), LDL-cholesterol (145.9 vs 173.5 mg/dl, p < 0.01), LH (2.1 vs 0.2 U/l, p < 0.001), FSH (3.3 vs 0.4 U/l, p < 0.001), free testosterone (14.4 vs 34.0 pg/ml, p < 0.001), 17-beta-estradiol and arm muscular section (98.8 vs 103.7 cm2, p < 0.001). The inclusion of testosterone in therapy introduced a significant difference with respect to the use of synthetic anabolic agents alone, in total testosterone (4.5 vs 0.9 ng/ml, p < 0.001) and 17-beta-oestradiol, but neither with respect to free testosterone nor arm muscular section. An 84.6% of individuals in the problem group stated to complete two therapy courses in a year.

CONCLUSIONS

The use of anabolic steroids increases the lean muscular mass. The most relevant secondary effects included: increased transaminase serum levels, change in the lipid profile and suppression of the hypothalamus-pituitary gland-gonad axis. The inclusion of testosterone did not increase the lean muscular mass.

Nutritional status and lipid profiles of trained steroid-using bodybuilders

Fourteen trained male anabolic steroid-using bodybuilders (SBBs) (19-41 years) were recruited for the study. Three-day diet records were obtained from SBBs and analyzed. A resting venous blood sample was drawn, and serum/plasma was subsequently analyzed for various nutritionally related factors. Results showed that mean dietary energy (4,469 +/- 1,406 kcal), protein 252 +/- 109 g), and vitamin and mineral intakes of SBBs greatly exceeded U.S. Recommended Dietary Allowances. Dietary cholesterol intake was 2.8 times the recommended levels. Mean serum/plasma nutrient concentrations of SBBs were within normal range. However, individual SBBs had a number of serum/plasma values outside of the normal or recommended range, the most notable of which was hypercalcemia, which was present in 42% of SBBs. Serum/plasma lipids were such as to increase the risk of cardiovascular disease in these subjects.

Validity of self-report in identifying anabolic steroid use among weightlifters

To determine the validity of self-report in the detection of anabolic steroid use among weightlifters, self-report was compared with assay results of simultaneous urine samples from 48 male weightlifters. The sensitivity of self-report in the detection of urinary anabolic steroids was 74%, and specificity was 82%. In addition, 22 of 23 participants who declared current use had at least one undeclared anabolic steroid identified in their urine. However, 15 participants reported at least one drug that was not detected in the urine. Furthermore, 3 of 17 declared nonusers had objective evidence of steroids in their urine. The validity of self-report may be inadequate to differentiate reliably between users and nonusers.

Resistance trained athletes using or not using anabolic steroids compared to runners: effects on cardiorespiratory variables, body composition, and plasma lipids

OBJECTIVE

To determine whether there is a difference in cardiac size and function as well as in body composition, aerobic capacity, and blood lipids between resistance trained athletes who use anabolic steroids and those who do not, and to compare them to university cross country athletes.

METHODS

Four groups of men were evaluated: recreational lifters, n = 11, lifting < 10 h.week-1; heavy lifters, n = 16, lifting > 10 h.week-1; steroid users, n = 8, same as heavy lifters and used steroids; runners, n = 8, university track members. Echocardiograms, body composition (hydrostatic weighing), maximum oxygen consumption (Vo2), and lipids were studied.

RESULTS

As expected, Vo2 (ml.kg-1.min-1), was greatest in the runners, with no difference among the lifting groups. High density lipoprotein cholesterol in the steroid user group was lower than in heavy lifters or runners. Left ventricular internal diastolic dimension was similar among the groups. The left ventricular mass index of the steroid user group was significantly greater than recreational lifters, at 161 v 103. There was no difference among heavy lifters (127), runners (124), and steroid users. There was no compromise in diastolic function in any group. There were no differences among groups in resting or exercise blood pressure.

CONCLUSIONS

Resistance training in the absence of steroid use results in the same positive effects on cardiac dimensions, diastolic function, and blood lipids as aerobic training.

Secondary causes of hyperlipidemia

Secondary causes of hyperlipidemia are important to recognize. In fact, hyperlipidemia may be a clue to the presence of an underlying systemic disorder. It may greatly heighten the risk of atherosclerosis with a raised LDL-c, triglyceride-rich lipoprotein excess, and increased lipoprotein(a) as well as lowered HDL-c. The search for secondary causes may provide a clue as to why patients with primary lipid disorders suddenly develop worsening lipid profiles. The point is a crucial one because some acquired causes of hyperlipidemia, such as alcohol, estrogens, steroids, or pregnancy, when superimposed on a primary familial form of hypertriglyceridemia can result in a saturated removal system and a buildup of chylomicrons, which can lead to life-threatening pancreatitis. A convenient way to remember secondary causes is to think of the four D's of diet, drugs, disorders of metabolism, and diseases. Although diets rich in saturated fats and cholesterol are a common cause of the mild hypercholesterolemia seen in our society, alcohol excess and weight gain can explain much of the tendency toward hypertriglyceridemia. Interestingly anorexia nervosa has long been associated with severe but reversible hypercholesterolemia. Several classes of drugs need to be considered as common causes of altered lipid profiles. Glucocorticoids and estrogens elevate triglycerides and raise levels of HDL-c. Anabolic steroids taken orally markedly reduce levels of HDL-c in contrast to injectable testosterone, which does not adversely affect the LDL-to-HDL ratio. Oral contraceptives affect atherosclerotic risk depending on the kind and doses of progestin/estrogen. In those with an underlying primary hypertriglyceridemia and associated obesity, estrogenic medications can depress triglyceride removal mechanisms, leading to the chylomicronemia syndrome and pancreatitis. Antihypertensives have variable effects on lipids and lipoproteins. Although short-term thiazide usage raises cholesterol, triglycerides, and LDL-c, long-term usage is not necessarily associated with significant alterations in lipid levels. Alpha blockers may cause an increase in HDL-c, whereas beta blockers raise triglycerides and lower HDL-c. Sympatholytics, angiotensin converting enzyme inhibitors, and calcium channel blockers are essentially lipid neutral. Retinoids can be associated with increased LDL-to-HDL ratios and occasionally striking elevations in triglycerides. Cyclosporine raises LDL-c and lipoprotein(a). Classes of drugs that may raise HDL-c include cimetidine, antiepileptic drugs, and tamoxifen, but the effect may be seen primarily in women. Hypothyroidism is the most common secondary cause of hyperlipidemia after dietary causes are considered. A thyroxine and TSH level should be obtained on all new cases of clinically important hyperlipidemia.(ABSTRACT TRUNCATED AT 400 WORDS)

Diet and exercise strategies of a world-class bodybuilder

This study presents the diet and exercise strategies of a world-class body-builder during an 8-week precompetition period. Weighed food records were kept daily, and body fat, resting metabolic rate (RMR), VO2max, blood lipids, and liver enzymes were measured. Two hrs of aerobic exercise and 3 hrs of weight training were done daily 6 days/week. Mean energy intake was 4,952 kcal/day (54 kcal/kg) and included 1,278 kcal/day from medium-chain triglycerides (MCT). Diet without MCT provided 76% of energy from carbohydrate, 19% from protein (1.9 g protein/kg), and 5% from fat. Micro-nutrients were consumed at > or = 100% of the RDA, except for zinc and calcium, without supplementation. Mean RMR was 2,098 kcal/day and represented 43% of energy intake. VO2max was 53 ml.kg-1.min-1. Underwater weighing showed that body fat decreased from 9% to 7%. Blood lipids were normal, but two liver enzymes were elevated (alanine and aspartate aminotransferase). This world-class bodybuilder achieved body fat goals by following a nutrient dense, high energy, high carbohydrate diet and an exercise program that emphasized both aerobic and anaerobic metabolism.

The efficacy of ergogenic agents in athletic competition. Part I: Androgenic-anabolic steroids

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.

Effects of physical exercise on sex hormone binding globulin, high density lipoprotein cholesterol, total cholesterol and triglycerides in postmenopausal women

This study was performed on 18 postmenopausal female volunteers in order to examine changes in sex hormone binding globulin (SHBG), high density lipoprotein cholesterol (HDLC), total cholesterol (TC) and serum triglyceride (TG) levels in a period of four months of moderate physical exercise. While SHBG decreased significantly (from 55.3 +/- 20.9 to 48.3 +/- 21.0 nM, P < 0.05), TG increased significantly (from 87 +/- 41.7 to 120.5 +/- 57.5 mg/dl, P < 0.001). These changes were accompanied by a significant decrease (P < 0.001) in body fat content. Other parameters such as HDL-cholesterol, TC and BMI did not change significantly. Plasma levels of SHBG were negatively correlated to serum TG both at the beginning (r = 0.492, P < 0.05) and at the end (r = 0.538, P < 0.05) of the period of moderate exercise. Also, changes in SHBG were negatively correlated with changes in BMI (r = 0.585, P < 0.05) and this could indicate that SHBG levels are more related to nutritional status than androgen/estrogen imbalance.

Relationship of skeletal muscle fiber type to serum high density lipoprotein cholesterol and apolipoprotein A-I levels

We measured the percentage of slow-twitch (ST) muscle fibers in the lateral portion of the quadriceps femoris muscle in 41 healthy sedentary male controls, 35 active male joggers, and 26 male coronary heart disease (CHD) patients. We then compared these percentages with serum levels of total cholesterol (TC), triglycerides (TG), high density lipoprotein cholesterol (HDL-C) and apolipoprotein A-I (apo A-I) found in these 102 middle-aged men. The percentage of ST muscle fibers in all men correlated positively with serum HDL-C (r = 0.57, P less than 0.001) and with apo A-I (r = 0.60, P less than 0.001) and negatively with triglycerides (r = -0.43, P less than 0.001). The proportion of ST fibers in joggers (65%; 61-69%, 95% confidence interval) was higher (P less than 0.001) than in sedentary controls (48%; 44-52%) or in CHD patients (44%; 39-49%). Moreover, 89% of the joggers had a proportion of ST fibers higher than 50%, whilst in sedentary controls and in CHD patients these values were 46% and 38%, respectively. Positive correlations were found between the percentage of ST fibers and both HDL-C and apo A-I in controls (r = 0.33, P less than 0.05 and r = 0.34, P less than 0.05) and in joggers (r = 0.46, P less than 0.01, and r = 0.40, P less than 0.05), respectively. Negative correlations in controls (r = -0.34, P less than 0.05) and in CHD patients (r = -0.43, P less than 0.05) were also found between the percentage of ST fibers and serum TG.(ABSTRACT TRUNCATED AT 250 WORDS)

Plasma lipid concentrations in professional cyclists after competitive cycle races

Plasma lipid concentrations were measured in professional cyclists at the beginning of the training season and both before the start and at the end of two cycle races of similar length (800 and 900 km in 6 days). Plasma concentrations of triglyceride, total and low density lipoprotein-cholesterol (LDL-C) and total cholesterol: high density lipoprotein-cholesterol (HDL-C) ratio were significantly lower and HDL-C concentrations significantly higher in cyclists compared to values in matched sedentary controls. At the end of the races, plasma concentrations of triglyceride and LDL-C were further reduced and HDL-C concentrations had increased compared to values at the start. At the end of the races, plasma concentrations of HDL-C were inversely correlated (r = -0.28, n = 45, P less than 0005) with triglyceride plasma concentrations. Body fat content, assessed as the sum of skinfold thicknesses was slightly reduced at the end of the race compared to the starting values. There was no significant correlation between skinfold thickness and plasma concentrations of HDL-C. Total plasma fatty acid concentrations were reduced and nonesterified fatty acids concentrations were increased at the end of the race compared to resting values. Consequently, the plasma concentrations of esterified fatty acids were significantly reduced after the race and there was a redistribution of the nonesterified fatty acids. The relative amounts of single fatty acids in the total fatty acid pool remained, however, remarkably constant. In conclusion, the results presented suggested that physical exercise, performed at the level of professional cyclists in a race, was an independent modifier of plasma lipid concentrations.

Recent developments in the toxicology of anabolic steroids

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.