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Dunn M, Dawe J, Eu B, Lee K, Piatkowski T, Stoové M. The health effects of non-prescribed anabolic-androgenic steroid use: Findings from The Performance and image-enhancing drugs UseRS' Health (PUSH) audit. Drug Alcohol Rev 2024. [PMID: 38973204 DOI: 10.1111/dar.13899] [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: 12/03/2023] [Revised: 06/17/2024] [Accepted: 06/21/2024] [Indexed: 07/09/2024]
Abstract
INTRODUCTION To ascertain the adverse health outcomes experienced by those using prescribed testosterone and non-prescribed anabolic-androgenic steroids presenting to general practitioner (GP) clinics. METHODS Retrospective clinical audit from nine GP clinics in major metropolitan areas across three Australian states. Data included demographic and individual characteristics (age, sexuality, body mass index, smoking status and HIV status); performance and image-enhancing drug use (type, reasons for use, patient-reported adverse effects); and blood biochemistry measurements (lipid profiles, liver function tests and red blood cell tests). Adverse health outcomes included evidence of polycythaemia, hypertension, liver abnormalities and hypercholesterolemia. RESULTS Three hundred men were identified as either using prescribed testosterone (66%; n = 197) or non-prescribed anabolic-androgenic steroids (AAS) (34%; n = 103). Individuals in the prescribed group were more likely to be older (p < 0.001), gay or bisexual (p < 0.001) and living with diagnosed HIV (p < 0.001) compared to individuals in the non-prescribed group. Abnormal liver function, polycythemia and gynecomastia were the top three adverse events experienced. When adjusting for age, sexuality, HIV status and smoking status, those who used non-prescribed AAS were more likely to experience any adverse event (aPR = 1.28; 95% CI 1.01-1.60; p = 0.038), hypertension (aPR = 1.86; 95% CI 1.19-2.91; p = 0.006) and liver abnormalities (aPR = 1.51; 95% CI 1.04-2.20; p = 0.030) compared to those using prescribed testosterone. DISCUSSION AND CONCLUSION For GPs who have clients who may be using, or who they suspect of using, AAS, these findings highlight the importance of not only exploring a patient's history of the adverse effects they have experienced, but that measuring for these other conditions may provide a more accurate clinical picture.
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Affiliation(s)
- Matthew Dunn
- School of Health and Social Development, Deakin University, Geelong, Australia
- Institute for Health Transformation, Deakin University, Geelong, Australia
| | | | - Beng Eu
- Prahran Market Clinic, Melbourne, Australia
- Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | - Kevin Lee
- Monash University, Melbourne, Australia
| | - Timothy Piatkowski
- School of Applied Psychology, Griffith University, Gold Coast, Australia
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Buhl LF, Lehmann Christensen L, Diederichsen A, Lindholt JS, Kistorp CM, Glintborg D, Andersen M, Frystyk J. Impact of androgenic anabolic steroid use on cardiovascular and mental health in Danish recreational athletes: protocol for a nationwide cross-sectional cohort study as a part of the Fitness Doping in Denmark (FIDO-DK) study. BMJ Open 2024; 14:e078558. [PMID: 38719280 PMCID: PMC11086435 DOI: 10.1136/bmjopen-2023-078558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 04/26/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION The use of androgenic anabolic steroids (AASs) among recreational athletes is steadily increasing. However, knowledge regarding the potentially harmful effects of AAS primarily originates from case reports and small observational studies. This large-scale study aims to investigate the impact of AAS use on vascular plaque formation, preclinical coronary disease, cardiac function, circulating cardiovascular risk markers, quality of life (QoL) and mental health in a broad population of illicit AAS users. METHODS AND ANALYSES A nationwide cross-sectional cohort study including a diverse population of men and women aged ≥18 years, with current or previous illicit AAS use for at least 3 months. Conducted at Odense University Hospital, Denmark, the study comprises two parts. In part A (the pilot study), 120 recreational athletes with an AAS history will be compared with a sex-matched and age-matched control population of 60 recreational athletes with no previous AAS use. Cardiovascular outcomes include examination of non-calcified coronary plaque volume and calcium score using coronary CT angiography, myocardial structure and function via echocardiography, and assessing carotid and femoral artery plaques using ultrasonography. Retinal microvascular status is evaluated through fundus photography. Cardiovascular risk markers are measured in blood. Mental health outcomes include health-related QoL, interpersonal difficulties, body image concerns, aggression dimensions, anxiety symptoms, depressive severity and cognitive function assessed through validated questionnaires. The findings of our comprehensive study will be used to compose a less intensive investigatory cohort study of cardiovascular and mental health (part B) involving a larger group of recreational athletes with a history of illicit AAS use. ETHICS AND DISSEMINATION The study received approval from the Regional Committee on Health Research Ethics for Southern Denmark (S-20210078) and the Danish Data Protection Agency (21/28259). All participants will provide signed informed consent. Research outcomes will be disseminated through peer-reviewed journals and scientific conferences. TRIAL REGISTRATION NUMBER NCT05178537.
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Affiliation(s)
- Laust Frisenberg Buhl
- Department of Endocrinology, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
| | | | - Axel Diederichsen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Caroline Michaela Kistorp
- Department of Hormones and Metabolism, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Kobenhavn, Denmark
| | - Dorte Glintborg
- Department of Endocrinology, Faculty of Health Sciences University of Southern Denmark, Odense, Denmark
| | - Marianne Andersen
- Department of Endocrinology, Faculty of Health Sciences University of Southern Denmark, Odense, Denmark
| | - Jan Frystyk
- Department of Endocrinology, Faculty of Health Sciences University of Southern Denmark, Odense, Denmark
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Grandperrin A, Ollive P, Kretel Y, Maufrais C, Nottin S. Impact of a 16-week strength training program on physical performance, body composition and cardiac remodeling in previously untrained women and men. Eur J Sport Sci 2024; 24:474-486. [PMID: 38895874 PMCID: PMC11170668 DOI: 10.1002/ejsc.12033] [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: 02/07/2023] [Revised: 07/09/2023] [Accepted: 08/22/2023] [Indexed: 06/21/2024]
Abstract
Even if more and more women are involved in strength-training (ST) programs in fitness centers, studies on strength gain, body composition, and cardiac remodeling were mainly conducted in men and whether they are similar in women remains to be explored. In this context, the aim of our study was to assess the effect of a supervised ST program on strength gains, body composition, and cardiac remodeling in previously untrained women and men. 17 healthy and previously untrained young women and 17 young men participated in a supervised 16-week ST program built according to the recommendation of the American College of Sports Medicine in terms of intensity, and strictly using similar volume and intensity in both groups. Strength performance, body composition, and cardiac remodeling were evaluated every 4 weeks. Cardiac adaptations were assessed using resting echocardiography, including regional 2D-Strain analysis of the left atrium and ventricle (LA and LV, respectively). Despite lower values at baseline, women exhibited similar or even higher strength gains compared to men. ST induced a decrease of body and abdominal fat mass and an increase of lean body mass in both groups. Similar cardiac remodeling was observed in women, and women, including an early and progressive LV and LA enlargement throughout the ST program, without any alteration of LV diastolic and systolic functions. These findings underlie that ST programs are highly suitable for women to enhance their strength performance and their cardiovascular health.
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Jaber M, Armand A, Rochette E, Monzy S, Greze V, Kanold J, Merlin E, Paysal J, Nottin S. Anthracycline-induced cardiotoxicity on regional myocardial work and left ventricular mechanical dispersion in adolescents and young adults in post-lymphoma remission. Cancer Med 2024; 13:e6857. [PMID: 38204211 PMCID: PMC10904967 DOI: 10.1002/cam4.6857] [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: 08/31/2023] [Revised: 11/28/2023] [Accepted: 12/10/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Myocardial work (MW) is a new echocardiographic tool with a high sensitivity to detect early and subtle alterations of myocardial function. We aimed to evaluate the late effects of anthracyclines by assessing the global and segmental MW and intraventricular mechanical dispersion from speckle tracking echocardiography in childhood lymphoma survivors (CLS). METHODS Thirty-one young adults including CLS and age-matched healthy controls were enrolled. All underwent echocardiography including an evaluation of left ventricular (LV) morphology and regional function. We assessed LV longitudinal (differentiating sub-endocardial and sub-epicardial layers), circumferential strains and twist, global and regional MW index (MWI). LV mechanical dispersion was assessed from the time dispersion of LV longitudinal strain, from myocardial wasted work (MWW) and myocardial work efficiency (MWE). RESULTS The longitudinal strains both at the level of the sub-endocardium and sub-epicardium were reduced in CLS compared to controls. The global MWI was also decreased (1668 ± 266 vs 1870 ± 264%.mmHg in CLS patients and controls, respectively, p < 0.05), especially on the apical segments. An increase of LV intraventricular mechanical dispersion was observed in CLS. MWW and MWE remained unchanged compared to controls. CONCLUSION Our results strongly support that cardiac remodeling is observed in CLS, characterized by a decrease in MW and an increase in LV mechanical dispersion. The apex is specifically altered, but its clinical significance remains uncertain. MW as a complement to strain seems interesting in cancer survivors to detect myocardial dysfunction at early stage and adapt their follow-up.
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Affiliation(s)
- Mohamed Jaber
- CHU Clermont‐Ferrand, Pédiatrie GénéraleClermont‐FerrandFrance
| | - Alexandre Armand
- CHU de Clermont‐Ferrand, Service Hématologie Oncologie PédiatriqueClermont‐FerrandFrance
| | - Emmanuelle Rochette
- CHU Clermont‐Ferrand, Pédiatrie GénéraleClermont‐FerrandFrance
- Université Clermont Auvergne, INSERMCIC 1405, CRECHE UnitClermont‐FerrandFrance
| | - Severine Monzy
- Cardiologue libéral, Pôle Santé RépubliqueClermont‐FerrandFrance
| | - Victoria Greze
- CHU de Clermont‐Ferrand, Service Hématologie Oncologie PédiatriqueClermont‐FerrandFrance
- Université Clermont Auvergne, INSERMCIC 1405, CRECHE UnitClermont‐FerrandFrance
| | - Justyna Kanold
- CHU de Clermont‐Ferrand, Service Hématologie Oncologie PédiatriqueClermont‐FerrandFrance
- Université Clermont Auvergne, INSERMCIC 1405, CRECHE UnitClermont‐FerrandFrance
| | - Etienne Merlin
- CHU Clermont‐Ferrand, Pédiatrie GénéraleClermont‐FerrandFrance
- CHU de Clermont‐Ferrand, Service Hématologie Oncologie PédiatriqueClermont‐FerrandFrance
| | - Justine Paysal
- CHU de Clermont‐Ferrand, Service Hématologie Oncologie PédiatriqueClermont‐FerrandFrance
- CHU Clermont‐Ferrand, Néonatologie et Réanimation PédiatriqueClermont‐FerrandFrance
| | - Stéphane Nottin
- Laboratory of Cardiovascular Adaptations to ExerciseAvignonFrance
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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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Pamart N, Drigny J, Azambourg H, Remilly M, Macquart M, Lefèvre A, Lahjaily K, Parienti JJ, Rocamora A, Guermont H, Desvergée A, Ollitrault P, Tournoux F, Saloux E, Normand H, Reboursière E, Gauthier A, Hodzic A. Effects of a 20-Week High-Intensity Strength Training Program on Muscle Strength Gain and Cardiac Adaptation in Untrained Men: Preliminary Results of a Prospective Longitudinal Study. JMIR Form Res 2023; 7:e47876. [PMID: 37874630 PMCID: PMC10630871 DOI: 10.2196/47876] [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: 04/05/2023] [Revised: 08/19/2023] [Accepted: 08/20/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND As strength sports gain popularity, there is a growing need to explore the impact of sustained strength training on cardiac biventricular structure and function, an area that has received less attention compared to the well-established physiological cardiac adaptation to endurance training. OBJECTIVE This study aims to implement a 20-week high-intensity strength training program to enhance maximal muscle strength and evaluate its impact on cardiac biventricular adaptation in healthy, untrained men. METHODS A total of 27 healthy and untrained young men (mean age 22.8, SD 3.2 years) participated in a strength training program designed to increase muscle strength. The training program involved concentric, eccentric, and isometric exercise phases, conducted over a consecutive 20-week time frame with a frequency of 3 weekly training sessions. Participants were evaluated before and after 12 and 20 weeks of training through body composition analysis (bioelectrical impedance), a 12-lead resting electrocardiogram, 3D transthoracic echocardiography, cardiopulmonary exercise testing, and muscle isokinetic dynamometry. The progression of strength training loads was guided by 1-repetition maximum (RM) testing during the training program. RESULTS Of the initial cohort, 22 participants completed the study protocol. No injuries were reported. The BMI (mean 69.8, SD 10.8 kg/m² vs mean 72, SD 11 kg/m²; P=.72) and the fat mass (mean 15.3%, SD 7.5% vs mean 16.5%, SD 7%; P=.87) remained unchanged after training. The strength training program led to significant gains in 1-RM exercise testing as early as 4 weeks into training for leg extension (mean 69.6, SD 17.7 kg vs mean 96.5, SD 31 kg; P<.001), leg curl (mean 43.2, SD 9.7 kg vs mean 52.8, SD 13.4 kg; P<.001), inclined press (mean 174.1, SD 41.1 kg vs mean 229.2, SD 50.4 kg; P<.001), butterfly (mean 26.3, SD 6.2 kg vs mean 32.5, SD 6.6 kg; P<.001), and curl biceps on desk (mean 22.9, SD 5.2 kg vs mean 29.6, SD 5.2 kg; P<.001). After 20 weeks, the 1-RM leg curl, bench press, pullover, butterfly, leg extension, curl biceps on desk, and inclined press showed significant mean percentage gains of +40%, +41.1%, +50.3%, +63.5%, +80.1%, +105%, and +106%, respectively (P<.001). Additionally, the isokinetic evaluation confirmed increases in maximal strength for the biceps (+9.2 Nm), triceps (+11.6 Nm), quadriceps (+46.8 Nm), and hamstrings (+25.3 Nm). In this paper, only the training and muscular aspects are presented; the cardiac analysis will be addressed separately. CONCLUSIONS This study demonstrated that a short-term high-intensity strength training program was successful in achieving significant gains in muscle strength among previously untrained young men. We intend to use this protocol to gain a better understanding of the impact of high-intensity strength training on cardiac physiological remodeling, thereby providing new insights into the cardiac global response in strength athletes. TRIAL REGISTRATION ClinicalTrials.gov NCT04187170; https://clinicaltrials.gov/study/NCT04187170.
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Affiliation(s)
- Nicolas Pamart
- Laboratoire Interuniversitaire de Biologie de la Motricité, Université Jean Monnet, Saint Etienne, France
| | - Joffrey Drigny
- Department of Sports Medicine, Normandie Université, Centre Hospitalier Universitaire de Caen Normandie, Caen, France
| | - Hélène Azambourg
- Department of Sports Medicine, Normandie Université, Centre Hospitalier Universitaire de Caen Normandie, Caen, France
| | - Marion Remilly
- Department of Sports Medicine, Normandie Université, Centre Hospitalier Universitaire de Caen Normandie, Caen, France
| | | | | | - Kamal Lahjaily
- Department of Cardiology, Normandie Université, Centre Hospitalier Universitaire de Caen Normandie, Caen, France
| | - Jean Jacques Parienti
- Centre de Recherche Clinique, Centre Hospitalier Universitaire de Caen Normandie, Caen, France
| | - Amélia Rocamora
- Centre de Recherche Clinique, Centre Hospitalier Universitaire de Caen Normandie, Caen, France
| | - Henri Guermont
- Department of Sports Medicine, Normandie Université, Centre Hospitalier Universitaire de Caen Normandie, Caen, France
| | - Antoine Desvergée
- Department of Sports Medicine, Normandie Université, Centre Hospitalier Universitaire de Caen Normandie, Caen, France
| | - Pierre Ollitrault
- Department of Sports Medicine, Normandie Université, Centre Hospitalier Universitaire de Caen Normandie, Caen, France
- Department of Cardiology, Normandie Université, Centre Hospitalier Universitaire de Caen Normandie, Caen, France
| | - Francois Tournoux
- Research Center of the Montreal University Hospital, Montreal University, Montreal, QC, Canada
| | - Eric Saloux
- Department of Cardiology, Normandie Université, Centre Hospitalier Universitaire de Caen Normandie, Caen, France
| | - Hervé Normand
- Inserm Comete, GIP Cyceron, Normandie Université, Caen, France
| | - Emmanuel Reboursière
- Department of Sports Medicine, Normandie Université, Centre Hospitalier Universitaire de Caen Normandie, Caen, France
| | - Antoine Gauthier
- UFR STAPS, Normandie Université, Caen, France
- Inserm Comete, GIP Cyceron, Normandie Université, Caen, France
| | - Amir Hodzic
- Department of Sports Medicine, Normandie Université, Centre Hospitalier Universitaire de Caen Normandie, Caen, France
- Department of Cardiology, Normandie Université, Centre Hospitalier Universitaire de Caen Normandie, Caen, France
- Inserm Comete, GIP Cyceron, Normandie Université, Caen, France
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