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Vauhkonen P, Oura P, Kriikku P, Lindroos K, Mäyränpää MI. Prediction model for anabolic androgenic steroid positivity in forensic autopsy cases - a new tool to the autopsy room. Int J Legal Med 2024; 138:1791-1800. [PMID: 38589641 PMCID: PMC11306540 DOI: 10.1007/s00414-024-03227-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 03/20/2024] [Indexed: 04/10/2024]
Abstract
Non-prescription use of anabolic androgenic steroids (AAS) is associated with an increased risk of premature death. However, these substances are seldom screened in connection with forensic cause-of-death investigation, unless the forensic pathologist specifically suspects use, often based on a positive AAS use history. Since AAS use is often concealed from others, this practice may lead to mistargeting of these analyses and significant underestimation of the true number of AAS positive cases undergoing forensic autopsy. Thus, more accurate diagnostic tools are needed to identify these cases. The main objective of this study was to determine, whether a multivariable model could predict AAS urine assay positivity in forensic autopsies. We analyzed retrospectively the autopsy reports of all cases that had been screened for AAS during forensic cause-of-death investigation between 2016-2019 at the Finnish Institute for Health and Welfare forensic units (n = 46). Binary logistic regression with penalized maximum likelihood estimation was used to generate a nine-variable model combining circumferential and macroscopic autopsy-derived variables. The multivariable model predicted AAS assay positivity significantly better than a "conventional" model with anamnestic information about AAS use only (area under the receiver operating characteristic curve [AUC] = 0.968 vs. 0.802, p = 0.005). Temporal validation was conducted in an independent sample of AAS screened cases between 2020-2022 (n = 31), where the superiority of the multivariable model was replicated (AUC = 0.856 vs. 0.644, p = 0.004). Based on the model, a calculator predicting AAS assay positivity is released as a decision-aiding tool for forensic pathologists working in the autopsy room.
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Affiliation(s)
- Paula Vauhkonen
- Forensic Medicine Unit, Finnish Institute for Health and Welfare, Mannerheimintie 166, P.O. Box 30, FI-00271, Helsinki, Finland.
- Faculty of Medicine, University of Helsinki, Haartmaninkatu 3, P.O. Box 63, FI-00014, Helsinki, Finland.
| | - Petteri Oura
- Forensic Medicine Unit, Finnish Institute for Health and Welfare, Mannerheimintie 166, P.O. Box 30, FI-00271, Helsinki, Finland
- Department of Forensic Medicine, Faculty of Medicine, University of Helsinki, Haartmaninkatu 3, P.O. Box 21, FI-00014, Helsinki, Finland
| | - Pirkko Kriikku
- Department of Forensic Medicine, Faculty of Medicine, University of Helsinki, Haartmaninkatu 3, P.O. Box 21, FI-00014, Helsinki, Finland
- Forensic Toxicology Unit, Finnish Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland
| | - Katarina Lindroos
- Forensic Medicine Unit, Finnish Institute for Health and Welfare, Mannerheimintie 166, P.O. Box 30, FI-00271, Helsinki, Finland
| | - Mikko Ilari Mäyränpää
- Department of Pathology, University of Helsinki, Haartmaninkatu 3, P.O. Box 21, FI-00014, Helsinki, Finland
- Helsinki University Hospital, P.O. Box 340, FI-00029, Helsinki, Finland
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Cecchi R, Camatti J, Bonasoni MP, Clemente GM, Nicolì S, Campanini N, Mozzoni P. HIF-1α expression by immunohistochemistry and mRNA-210 levels by real time polymerase chain reaction in post-mortem cardiac tissues: A pilot study. Leg Med (Tokyo) 2024; 71:102508. [PMID: 39137459 DOI: 10.1016/j.legalmed.2024.102508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Revised: 08/06/2024] [Accepted: 08/06/2024] [Indexed: 08/15/2024]
Abstract
INTRODUCTION The postmortem diagnosis of acute myocardial ischemia (AMI) represents a challenging issue in forensic practice. Immunohistochemical studies and gene expression studies are becoming a promising field of research in forensic pathology. The present study aims to evaluate HIF-1α expression through immunohistochemistry (IHC), and mRNA-210 level using real-time polymerase chain reaction (RT-PCR), in order to define if HIF-1α and mRNA-210 in post-mortem myocardium could be adopted in the diagnosis of AMI. MATERIALS AND METHODS Thirty-five deceased individuals, who underwent forensic autopsy at the Legal Medicine Service of the University of Parma, between 2010 and 2018, were investigated. The cohort was divided into two groups according to the cause of death (sudden deaths caused by AMI vs control cases). Cardiac specimens were collected during autopsy, then samples were processed for morphological evaluation using haematoxylin-eosin staining, for IHC, and for RT-PCR. HIF-1α expression and mRNA-210 levels were investigated. RESULTS Statistical evaluation demonstrated statistically significant differences in terms of number of IHC positive vessels, leukocytes, and cardiomyocytes between the two groups. Moreover, in the majority of cases, immunostaining positivity was observed only in myocardial and subendocardial samples. With reference to mRNA-210, the difference between the two groups proved to be statistically significant. CONCLUSIONS The present study indicates that HIF-1α and mRNA-210 in post-mortem cardiac specimens could represent appropriate biomarkers in the diagnosis of AMI. The current study was primarily limited by the scarcity of the cohort, so further research is required to confirm these preliminary observations.
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Huang W, Zhao S, Liu H, Pan M, Dong H. The Role of Protein Degradation in Estimation Postmortem Interval and Confirmation of Cause of Death in Forensic Pathology: A Literature Review. Int J Mol Sci 2024; 25:1659. [PMID: 38338938 PMCID: PMC10855206 DOI: 10.3390/ijms25031659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 01/04/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024] Open
Abstract
It is well known that proteins are important bio-macromolecules in human organisms, and numerous proteins are widely used in the clinical practice, whereas their application in forensic science is currently limited. This limitation is mainly attributed to the postmortem degradation of targeted proteins, which can significantly impact final conclusions. In the last decade, numerous methods have been established to detect the protein from a forensic perspective, and some of the postmortem proteins have been applied in forensic practice. To better understand the emerging issues and challenges in postmortem proteins, we have reviewed the current application of protein technologies at postmortem in forensic practice. Meanwhile, we discuss the application of proteins in identifying the cause of death, and postmortem interval (PMI). Finally, we highlight the interpretability and limitations of postmortem protein challenges. We believe that utilizing the multi-omics method can enhance the comprehensiveness of applying proteins in forensic practice.
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Affiliation(s)
- Weisheng Huang
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Hankou, Wuhan 430030, China; (W.H.)
| | - Shuquan Zhao
- Faculty of Forensic Pathology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China;
| | - Huine Liu
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Hankou, Wuhan 430030, China; (W.H.)
| | - Meichen Pan
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Hankou, Wuhan 430030, China; (W.H.)
| | - Hongmei Dong
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Hankou, Wuhan 430030, China; (W.H.)
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4
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Place F, Carpenter H, Morrison BN, Chester N, Cooper R, Stansfield BN, George KP, Oxborough D. The impact of image and performance enhancing drugs on atrial structure and function in resistance trained individuals. Echo Res Pract 2023; 10:19. [PMID: 38053157 DOI: 10.1186/s44156-023-00031-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 10/09/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Image and performance enhancing drugs (IPEDs) are commonly used in resistance trained (RT) individuals and negatively impact left ventricular (LV) structure and function. Few studies have investigated the impact of IPEDs on atrial structure and function with no previous studies investigating bi-atrial strain. Additionally, the impact of current use vs. past use of IPEDs is unclear. METHODS Utilising a cross-sectional design, male (n = 81) and female (n = 15) RT individuals were grouped based on IPED user status: current (n = 57), past (n = 19) and non-users (n = 20). Participants completed IPED questionnaires, anthropometrical measurements, electrocardiography, and transthoracic echocardiography with strain imaging. Structural cardiac data was allometrically scaled to body surface area (BSA) according to laws of geometric similarity. RESULTS Body mass and BSA were greater in current users than past and non-users of IPEDs (p < 0.01). Absolute left atrial (LA) volume (60 ± 17 vs 46 ± 12, p = 0.001) and right atrial (RA) area (19 ± 4 vs 15 ± 3, p < 0.001) were greater in current users than non-users but this difference was lost following scaling (p > 0.05). Left atrial reservoir (p = 0.008, p < 0.001) and conduit (p < 0.001, p < 0.001) strain were lower in current users than past and non-users (conduit: current = 22 ± 6, past = 29 ± 9 and non-users = 31 ± 7 and reservoir: current = 33 ± 8, past = 39 ± 8, non-users = 42 ± 8). Right atrial reservoir (p = 0.015) and conduit (p = 0.007) strain were lower in current than non-users (conduit: current = 25 ± 8, non-users = 33 ± 10 and reservoir: current = 36 ± 10, non-users = 44 ± 13). Current users showed reduced LV diastolic function (A wave: p = 0.022, p = 0.049 and E/A ratio: p = 0.039, p < 0.001) and higher LA stiffness (p = 0.001, p < 0.001) than past and non-users (A wave: current = 0.54 ± 0.1, past = 0.46 ± 0.1, non-users = 0.47 ± 0.09 and E/A ratio: current = 1.5 ± 0.5, past = 1.8 ± 0.4, non-users = 1.9 ± 0.4, LA stiffness: current = 0.21 ± 0.7, past = 0.15 ± 0.04, non-users = 0.15 ± 0.07). CONCLUSION Resistance trained individuals using IPEDs have bi-atrial enlargement that normalises with allometric scaling, suggesting that increased size is, in part, associated with increased body size. The lower LA and RA reservoir and conduit strain and greater absolute bi-atrial structural parameters in current than non-users of IPEDs suggests pathological adaptation with IPED use, although the similarity in these parameters between past and non-users suggests reversibility of pathological changes with withdrawal.
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Affiliation(s)
- Florence Place
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Byrom Street, Liverpool, L3 3AF, UK
| | - Harry Carpenter
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Byrom Street, Liverpool, L3 3AF, UK
| | - Barbara N Morrison
- School of Human Kinetics, Trinity Western University, Langley, BC, Canada
| | - Neil Chester
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Byrom Street, Liverpool, L3 3AF, UK
| | - Robert Cooper
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Byrom Street, Liverpool, L3 3AF, UK
| | - Ben N Stansfield
- Department of Pharmacology and Toxicology, College of Pharmacy, University of Arizona, Arizona, USA
| | - Keith P George
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Byrom Street, Liverpool, L3 3AF, UK
| | - David Oxborough
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Byrom Street, Liverpool, L3 3AF, UK.
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Leciejewska N, Pruszyńska-Oszmałek E, Nogowski L, Sassek M, Strowski MZ, Kołodziejski PA. Sex-specific cytotoxicity of ostarine in cardiomyocytes. Mol Cell Endocrinol 2023; 577:112037. [PMID: 37543162 DOI: 10.1016/j.mce.2023.112037] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 06/06/2023] [Accepted: 07/31/2023] [Indexed: 08/07/2023]
Abstract
Ostarine is the most popular compound in the selective androgen receptor modulator group (SARMs). Ostarine is used as a physical performance-enhancing agent. The abuse of this agent in higher doses may lead to severe side effects. Here, we evaluate the effects of ostarine on the heart. We utilized a cardiomyocyte H9C2 cell line, isolated primary female and male cardiac fibroblast cells, as well as hearts obtained from rats. Ostarine increased the accumulation of two fibrosis protein markers, αSMA and fibronectin (p < 00.1) in male, but not in female fibroblast cells. Ostarine increased the expression of the cardiomyopathy marker βMhc in the H9C2 cell line (p < 0.05) and in the heart in rats (p < 0.01). The unfavorable changes were observed at high ostarine doses. Moreover, a decrease in viability and an increase in cytotoxicity marker LDH were observed already at lowest dose (1 nmoL/l). Taken together, our results suggest that ostarine is cardiotoxic which may be more relevant in males than in females.
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Affiliation(s)
- Natalia Leciejewska
- Department of Animal Physiology, Biochemistry and Biostructure, Poznan University of Life Sciences, 60-637, Poznan, Poland
| | - Ewa Pruszyńska-Oszmałek
- Department of Animal Physiology, Biochemistry and Biostructure, Poznan University of Life Sciences, 60-637, Poznan, Poland.
| | - Leszek Nogowski
- Department of Animal Physiology, Biochemistry and Biostructure, Poznan University of Life Sciences, 60-637, Poznan, Poland
| | - Maciej Sassek
- Department of Animal Physiology, Biochemistry and Biostructure, Poznan University of Life Sciences, 60-637, Poznan, Poland
| | - Mathias Z Strowski
- Department of Hepatology and Gastroenterology, Charité-University Medicine Berlin, 13353, Berlin, Germany; Medical Clinic III, 15236, Frankfurt (Oder), Germany
| | - Paweł A Kołodziejski
- Department of Animal Physiology, Biochemistry and Biostructure, Poznan University of Life Sciences, 60-637, Poznan, Poland.
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Adhikari G, Khan A, Shams N, Hassan MH, Kunadi A. A unique case of tachycardia‐mediated cardiomyopathy in a patient misusing anabolic steroids. Clin Case Rep 2022; 10:e5976. [PMID: 35734186 PMCID: PMC9194462 DOI: 10.1002/ccr3.5976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 05/11/2022] [Accepted: 06/03/2022] [Indexed: 01/09/2023] Open
Abstract
A 54‐year‐old male patient with history of anabolic androgenic steroid (AAS) misuse presented to the emergency department with new‐onset atrial fibrillation and severely reduced ejection fraction. Cardiac catheterization revealed normal coronaries. He underwent cryo‐balloon ablation with subsequent conversion to sinus rhythm. After appropriate guideline‐directed medical management, ejection fraction improved on follow‐up.
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Affiliation(s)
- Govinda Adhikari
- Department of Internal Medicine McLaren‐Flint/MSU Flint Michigan USA
| | - Ashiya Khan
- Department of Internal Medicine McLaren‐Flint/MSU Flint Michigan USA
| | - Nasheed Shams
- Department of Internal Medicine McLaren‐Flint/MSU Flint Michigan USA
| | | | - Arvind Kunadi
- Department of Internal Medicine McLaren‐Flint/MSU Flint Michigan USA
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Adami PE, Koutlianos N, Baggish A, Bermon S, Cavarretta E, Deligiannis A, Furlanello F, Kouidi E, Marques-Vidal P, Niebauer J, Pelliccia A, Sharma S, Solberg EE, Stuart M, Papadakis M. Cardiovascular effects of doping substances, commonly prescribed medications and ergogenic aids in relation to sports: a position statement of the sport cardiology and exercise nucleus of the European Association of Preventive Cardiology. Eur J Prev Cardiol 2022; 29:559-575. [PMID: 35081615 DOI: 10.1093/eurjpc/zwab198] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/30/2021] [Accepted: 11/09/2021] [Indexed: 02/06/2023]
Abstract
The use of substances and medications with potential cardiovascular effects among those practicing sports and physical activity has progressively increased in recent years. This is also connected to the promotion of physical activity and exercise as core aspects of a healthy lifestyle, which has led also to an increase in sport participation across all ages. In this context, three main users' categories can be identified, (i) professional and amateur athletes using substances to enhance their performance, (ii) people with chronic conditions, which include physical activity and sport in their therapeutic plan, in association with prescribed medications, and (iii) athletes and young individuals using supplements or ergogenic aids to integrate their diet or obtaining a cognitive enhancement effect. All the substances used for these purposes have been reported to have side effects, among whom the cardiovascular consequences are the most dangerous and could lead to cardiac events. The cardiovascular effect depends on the type of substance, the amount, the duration of use, and the individual response to the substances, considering the great variability in responses. This Position Paper reviews the recent literature and represents an update to the previously published Position Paper published in 2006. The objective is to inform physicians, athletes, coaches, and those participating in sport for a health enhancement purpose, about the adverse cardiovascular effects of doping substances, commonly prescribed medications and ergogenic aids, when associated with sport and exercise.
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Affiliation(s)
- Paolo Emilio Adami
- Health and Science Department, World Athletics, 6-8 Quai Antoine 1er, Monaco 98000, Monaco
| | - Nikolaos Koutlianos
- Sports Medicine Laboratory, Aristotle University of Thessaloniki, Thermi, AUTH DPESS, 54124, Thessaloniki, Greece
| | - Aaron Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, 55 Fruit Street Boston, MA 02114, USA
| | - Stéphane Bermon
- Health and Science Department, World Athletics, 6-8 Quai Antoine 1er, Monaco 98000, Monaco
| | - Elena Cavarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica, 79 - 04100 - Latina (LT), Italy.,Mediterranea Cardiocentro, Via Orazio, 2, 80122, Napoli (NA), Italy
| | - Asterios Deligiannis
- Sports Medicine Laboratory, Aristotle University of Thessaloniki, Thermi, AUTH DPESS, 54124, Thessaloniki, Greece
| | - Francesco Furlanello
- Aritmologia Clinica e Sportiva, IRCCS Gruppo MultiMedica Elettrofisiologia, Via Milanese 300, 20099, Sesto San Giovanni(MI), Italy
| | - Evangelia Kouidi
- Sports Medicine Laboratory, Aristotle University of Thessaloniki, Thermi, AUTH DPESS, 54124, Thessaloniki, Greece
| | - Pedro Marques-Vidal
- Department of Medicine, Internal Medicine, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Josef Niebauer
- Paracelsus Medical University, Strubergasse 21, 5020 Salzburg, Austria
| | - Antonio Pelliccia
- Sports Medicine and Science Institute, CONI, Largo Piero Gabrielli, 1, 00197, Rome, Italy
| | - Sanjay Sharma
- Cardiovascular Clinical Academic Group, St George's, University of London, Cranmer Terrace, London SW17 0RE, UK
| | | | - Mark Stuart
- International Testing Agency-ITA, Av. de Rhodanie 58, 1007 Lausanne, Switzerland
| | - Michael Papadakis
- Cardiovascular Clinical Academic Group, St George's, University of London, Cranmer Terrace, London SW17 0RE, UK
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Gadela NV, Coban H, Wasserman E, Schreyer E, Jaiswal A. The Tragedy of a Strong Muscle and a Weak Heart: Complications of Anabolic-Androgenic Steroid Misuse. Cureus 2021; 13:e17389. [PMID: 34584799 PMCID: PMC8457317 DOI: 10.7759/cureus.17389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2021] [Indexed: 11/05/2022] Open
Abstract
Misuse of anabolic-androgenic steroids (AAS) to boost performance and appearance is rising in the United States (US) with approximately one million people experiencing dependence. Long-term AAS misuse can lead to cardiovascular pathology but rarely cardiogenic shock. We report the case of an acute ischemic stroke secondary to an intracardiac thrombus in a patient with biventricular failure and cardiogenic shock associated with AAS misuse. Discontinuation of AAS and institution of guideline-directed medical therapy might reverse AAS-related heart failure.
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Affiliation(s)
| | - Hamza Coban
- Neurology, University of Connecticut, Farmington, USA
| | - Evan Wasserman
- Internal Medicine, University of Connecticut, Farmington, USA
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Zheng J, Ye C, Wang P, Liu Y, Yang H, Liu H. Quantitative analysis of total methenolone in animal source food by liquid chromatography-tandem mass spectrometry. Drug Test Anal 2020; 13:148-155. [PMID: 32852087 DOI: 10.1002/dta.2915] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 08/11/2020] [Accepted: 08/14/2020] [Indexed: 11/10/2022]
Abstract
Methenolone, an anabolic androgenic steroid, has been applied to improve the quality and protein content of meat in animal husbandry. However, the usage of methenolone in sports is banned for its doping effects. Several methods have been reported to monitor the content of methenolone in serum and urine samples, but a highly sensitive detection system has not been developed for the determination of methenolone in animal source food due to its constituent complexity. In this study, a novel detection system was developed to quantify the contents of both free and conjugated methenolone in animal source food including pork, beef, mutton, milk, and eggs by using high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) coupled with delicate pretreatment procedures. The conjugated methenolone in the above food samples was released by dual enzyme digestion, and the total methenolone was extracted by 1% formic acid in acetonitrile, followed by the purification using a PRiME HLB column or QuEChERS (Quick, Easy, Cheap, Effective, Rugged, and Safe) salt. The compound d3 -methyltestosterone was used as an internal standard to minimize matrix interference. Finally, a wide linear range (0.5-20 μg/kg), low limit of detection (LOD) (0.3 μg/kg), good precision (<7% relative standard deviation), and high recovery (>90%) were obtained in the study of method validation. In summary, this analytical method provides a practicable monitoring tool for the quantification of methenolone in animal source food.
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Affiliation(s)
- Junping Zheng
- College of Life Sciences, Wuchang University of Technology, Wuhan, China.,School of Basic Medical Sciences, Hubei University of Chinese Medicine, Wuhan, China
| | - Cheng Ye
- Wuhan Customs Technology Center, Wuhan Customs District P.R. China, Wuhan, China
| | - Peng Wang
- Wuhan Customs Technology Center, Wuhan Customs District P.R. China, Wuhan, China
| | - Yang Liu
- College of Life Sciences, Wuchang University of Technology, Wuhan, China
| | - Huabing Yang
- School of Basic Medical Sciences, Hubei University of Chinese Medicine, Wuhan, China
| | - Hongtao Liu
- School of Basic Medical Sciences, Hubei University of Chinese Medicine, Wuhan, China
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Perry JC, Schuetz TM, Memon MD, Faiz S, Cancarevic I. Anabolic Steroids and Cardiovascular Outcomes: The Controversy. Cureus 2020; 12:e9333. [PMID: 32850208 PMCID: PMC7444848 DOI: 10.7759/cureus.9333] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Anabolic steroids (AS) are synthetic derivatives of the male sex hormone testosterone. The use of AS is not limited to bodybuilders and athletes, but non-athletes also use them. It is used to enhance athletic performance, induce muscle hypertrophy, and augment male sexual characteristics. AS use is associated with a wide range of side effects and potential cardiovascular complications. In this article, we have searched the available literature to investigate the association between AS use and cardiovascular disease (CVD). The results revealed that AS was linked to lipid metabolism derangements, hypertension, coagulation disorders, and cardiomyopathy. We concluded, based on the relevant data, that there was evidence that suggests an association with CVD, primarily myocardial infarction, fatal arrhythmias, and cardiomyopathy in AS users. The general population should be informed of the risk. Also, methods of primary and secondary prevention should be implemented to mitigate the risk of CVD secondary to AS.
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Affiliation(s)
- Jamal C Perry
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Tayná M Schuetz
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Mohammad D Memon
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Sadaf Faiz
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Ivan Cancarevic
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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11
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Kaya Ü, Eren H, Öcal L, İnanır M, Balaban İ. Association between fragmented QRS complexes and left-ventricular dysfunction in anabolic androgenic steroid users. Acta Cardiol 2020; 75:244-253. [PMID: 31663816 DOI: 10.1080/00015385.2019.1682339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Anabolic androgen steroid (AS) use has adverse effects on left ventricular functions, such as fibrosis development. Fragmented QRS is an important marker of myocardial fibrosis, while speckle-tracking echocardiographyis a method used to show subclinical left ventricle dysfunction. In this study, we examined the the ability of fQRS + to detect left ventricle fibrosis by speckle tracking echocardiography (STE) in AS users.Methods: The study included a total of 181 healthy athletes. Athletes were divided into two groups as AS users (n = 89) and non-AS users (n = 92). Then, athletes using AS were divided into two groups as fQRS+ (n = 52) and fQRS- (n = 37). In both groups, the arithmetic mean of three images was used to obtain the left ventricle global longitudinal strain (LV-GLS). The E/SRe ratio was also calculated and analysed.Results: There were significant differences between the AS users and non-AS users in terms of, E/SRe (55.7 ± 17.9 vs 50.3 ± 14.8; p = 0.015), LV-GLS (23.1 ± 1.9 vs 24.0 ± 1.7; p = 0.001), and fQRS (18.5% vs 6%; p = 0.005). When subgroup analysis was performed, both LV-GLS and E/SRivr were found to be poor in the fQRS + group. When multiple linear regression analysis was performed, we determined fQRS as an independent predictor for LV-GLS and E/SRivr ratio.Conclusion: In conclusion, our study demonstrated that fQRS is a parameter that can beused to determine left ventricle subclinical systolic and diastolic dysfunction in AS users. It can be used for cessation of drug use, especially in long-term use.
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Affiliation(s)
- Ülker Kaya
- Department of Cardiology, Elbistan State Hospital, Kahramanmaraş, Turkey
| | - Hayati Eren
- Department of Cardiology, Elbistan State Hospital, Kahramanmaraş, Turkey
| | - Lütfi Öcal
- Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - Mehmet İnanır
- Department of Cardiology, Abant Izzet Baysal University Hospital, Bolu, Turkey
| | - İsmail Balaban
- Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
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12
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Abstract
OBJECTIVE Anabolic-androgenic steroids (AAS) represents a group of synthetic testosterone derivatives that play an important role in clinical treatment. These drugs are widely abused among the general public to increase lean weight and improve athletic performance. It has been reported that AAS use can produce many adverse effects, especially the occurrence of cardiovascular risk. Although there are many related studies, there has been no consensus on AAS use and cardiovascular risk. The present study was to review the effect of AAS on the cardiovascular system. DATA SOURCES The data in this review were obtained from articles included in PubMed and the National Center for Biotechnology Information database. STUDY SELECTION Original articles, case reports, and systematic reviews about AAS were selected for the article. RESULTS The use/abuse of AAS is correlated with higher cardiovascular risks, and many AAS users/abusers had cardiovascular diseases. However, there are many confounding factors in the studies that explored the causality between AAS intake and disease development, and additional studies are required to determine AAS toxicity. CONCLUSION AAS produces toxic effects on the cardiovascular system, and it is necessary to ensure that more people know this about AAS, including medical personnel.
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Affiliation(s)
- Jian-Di Liu
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China
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13
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Vieira TM, Rossi Junior WC, Da Ré Guerra F, Damião B, Marques PP, Esteves A. Effect of testosterone cypionate and stanozolol on the heart of young trained mice: A morphometric study. Steroids 2019; 145:19-22. [PMID: 30772437 DOI: 10.1016/j.steroids.2019.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 02/12/2019] [Indexed: 11/20/2022]
Abstract
Testosterone cypionate and Stanozolol are Anabolic-Androgenic Steroids (AAS) which are synthetic substances that possess functions similar to testosterone. The use of these substances has increased considerably among youngsters and sports practitioners aiming better performance of with aesthetic purposes. The major concern is the effects caused by the inappropriate use of the substances, such as hypertension, myocardial ischemia, and left ventricle hypertrophy. The objective of the present research was to measure the diameter of the left ventricle lumen and the thickness of the left ventricle myocardium in mice submitted to supraphysiological doses of AAS. A total of 30 female Swiss mice were used in the experiments. The animals received supraphysiological doses of the AAS for 30 days, and during the treatment period, they were put to swim in intercalated days. After treatment animals were euthanized and slides were made from the hearts for measurements. Results demonstrated that both AAS changed significantly the heart morphology: Testosterone cypionate led to an increase in the ventricular lumen and stanozolol increased left ventricle myocardium thickness. In conclusion, the use of AAS in supraphysiological doses can change the heart morphology and can lead to serious health consequences.
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Affiliation(s)
- Tânia Martins Vieira
- Institute of Biomedical Sciences, Department of Anatomy, Federal University of Alfenas, Alfenas, Brazil
| | - Wagner Costa Rossi Junior
- Institute of Biomedical Sciences, Department of Anatomy, Federal University of Alfenas, Alfenas, Brazil
| | - Flávia Da Ré Guerra
- Institute of Biomedical Sciences, Department of Anatomy, Federal University of Alfenas, Alfenas, Brazil
| | - Bruno Damião
- Doctorate in the Program of Pharmaceutical Sciences, Federal University of Alfenas, Alfenas, Brazil
| | - Petrus Pires Marques
- Department of Morphology, Medical School, José Vellano University, Unifenas, Alfenas, Brazil
| | - Alessandra Esteves
- Institute of Biomedical Sciences, Department of Anatomy, Federal University of Alfenas, Alfenas, Brazil.
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14
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Kaufman MJ, Kanayama G, Hudson JI, Pope HG. Supraphysiologic-dose anabolic-androgenic steroid use: A risk factor for dementia? Neurosci Biobehav Rev 2019; 100:180-207. [PMID: 30817935 PMCID: PMC6451684 DOI: 10.1016/j.neubiorev.2019.02.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 02/13/2019] [Accepted: 02/17/2019] [Indexed: 02/06/2023]
Abstract
Supraphysiologic-dose anabolic-androgenic steroid (AAS) use is associated with physiologic, cognitive, and brain abnormalities similar to those found in people at risk for developing Alzheimer's Disease and its related dementias (AD/ADRD), which are associated with high brain β-amyloid (Aβ) and hyperphosphorylated tau (tau-P) protein levels. Supraphysiologic-dose AAS induces androgen abnormalities and excess oxidative stress, which have been linked to increased and decreased expression or activity of proteins that synthesize and eliminate, respectively, Aβ and tau-P. Aβ and tau-P accumulation may begin soon after initiating supraphysiologic-dose AAS use, which typically occurs in the early 20s, and their accumulation may be accelerated by other psychoactive substance use, which is common among non-medical AAS users. Accordingly, the widespread use of supraphysiologic-dose AAS may increase the numbers of people who develop dementia. Early diagnosis and correction of sex-steroid level abnormalities and excess oxidative stress could attenuate risk for developing AD/ADRD in supraphysiologic-dose AAS users, in people with other substance use disorders, and in people with low sex-steroid levels or excess oxidative stress associated with aging.
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Affiliation(s)
- Marc J Kaufman
- McLean Imaging Center, McLean Hospital, 115 Mill St., Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA.
| | - Gen Kanayama
- Biological Psychiatry Laboratory, McLean Hospital, 115 Mill St., Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
| | - James I Hudson
- Biological Psychiatry Laboratory, McLean Hospital, 115 Mill St., Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
| | - Harrison G Pope
- Biological Psychiatry Laboratory, McLean Hospital, 115 Mill St., Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
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Abstract
PURPOSE OF REVIEW To summarize recent findings regarding the public health impact of androgen abuse. RECENT FINDINGS Abuse of androgens (also called 'anabolic-androgenic steroids') has grown into a major worldwide substance abuse problem involving tens of millions of individuals, of whom about 98% are men. Most androgen abusers are still under age 50 today, and thus, the long-term effects of these drugs are only beginning to be understood. Recent studies confirm that long-term supraphysiologic androgen exposure produces cardiovascular toxicity, characterized especially by cardiomyopathy and atherosclerotic disease. Withdrawal from androgens after long-term use may produce prolonged and sometimes irreversible hypogonadism in men. Supraphysiologic androgen levels may sometimes cause irritability, aggressiveness, and violence, whereas androgen withdrawal may cause depression. However, these psychiatric effects are idiosyncratic, affecting only a minority of users. Emerging evidence now also suggests that long-term androgen exposure may cause neurotoxicity, raising the possibility that aging androgen abusers may be at increased risk for dementia. Several recent studies have also described androgen-induced hepatotoxicity, nephrotoxicity, and adverse musculoskeletal effects. SUMMARY Recent studies have demonstrated marked adverse effects of long-term androgen abuse. As increasing numbers of androgen abusers reach middle age, these effects will likely represent an emerging public health problem.
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Affiliation(s)
- Gen Kanayama
- Department of Psychiatry, Harvard Medical School, McLean Hospital, Boston, Massachusetts, USA
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