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Moudgal R, Peritz DC, Turco J, Taub C. Cardiac Mechanics in Altered Hormonal States as a Surrogate for Understanding the Effects of Transgender Hormone Therapy. Cardiol Rev 2024; 32:75-82. [PMID: 35950948 DOI: 10.1097/crd.0000000000000473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Transgender individuals are increasingly seeking the care of physicians to physically transition to their self-identified gender identity. Gender-affirming hormone therapy (GAHT) has significant endocrine effects which may have cardiovascular consequences, and cardiovascular disease in transgender individuals is a growing area of study. The effects of GAHT on cardiac mechanics have yet to be characterized, but there is existing literature regarding changes to cardiac mechanics in similar altered hormonal states. We reviewed this literature, with a focus on echocardiographic findings. We found variable results between studies of different methodologies. These include findings that supraphysiological levels of testosterone may impair cardiac mechanics, whereas estrogen-containing hormonal replacement therapy may improve diastolic echocardiographic parameters. In summary, there are alterations to echocardiographic parameters in altered endocrine states related to exogenous testosterone and estrogen, in a manner that is likely dose-dependent. Encouragingly, the studies we reviewed did not suggest that hormonal changes within physiologic ranges would detrimentally affect echocardiographic parameters of systolic and diastolic function. Future research into the cardiovascular effects of long-term GAHT is warranted to safely guide the longitudinal treatment of transgender individuals.
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Affiliation(s)
- Rohitha Moudgal
- From the Department of Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - David C Peritz
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - John Turco
- Department of Endocrinology, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Cynthia Taub
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH
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2
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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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Hammoud S, van den Bemt BJF, Jaber A, Kurdi M. Chronic anabolic androgenic steroid administration reduces global longitudinal strain among off-cycle bodybuilders. Int J Cardiol 2023; 381:153-160. [PMID: 37003371 DOI: 10.1016/j.ijcard.2023.03.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/15/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Supra-physiologic doses of anabolic androgenic steroids (AAS) lead to multiple cardiovascular complications. The long-term clinical effect of AAS overuse on cardiac structure and function, which persists during off-cycle periods, remains unclear. METHODS A total of 15 sedentary subjects and 79 bodybuilders (26 AAS non-users and 53 AAS-users), matched for age and male gender, were assessed in a cross-sectional design for echocardiography measures. AAS-users were included during an off-cycle phase, abstained from AAS for at least 1 month. 2D standard M-mode and speckle tracking echocardiography were used to measure cardiac dimensions and functions. RESULTS Inter-ventricular septum and posterior wall thickness were significantly higher among chronic off-cycle AAS-users compared to AAS non-users and sedentary group. Off-cycle AAS-users showed lower E/A ratio of the diastolic function. Left ventricular systolic function was not affected in terms of ejection fraction, but significant subclinical systolic dysfunction, assessed by GLS, was observed for chronic off-cycle AAS-users compared to AAS non-users (GLS = -16.8% vs. -18.5%, respectively; p = 0.001). Diameter of left atrium and right ventricle were significantly enlarged among off-cycle AAS-user bodybuilders (p = 0.002 and 0.040). TAPSE and RV S', and cardiac vasculature of aorta were comparable in all groups. CONCLUSIONS This study demonstrates that during off-cycle phase, AAS-users show long-term impaired GLS, even after considerable AAS abstain, despite normal LVEF. It highlights the importance of following GLS to predict hypertrophy and heart failure events, and not relying on LVEF alone. In addition, the hypertrophic effect of chronic AAS consumption is transitional during AAS washout periods.
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Affiliation(s)
- Sabah Hammoud
- Laboratory of Experimental and Clinical Pharmacology, Faculty of Sciences, Section 1, Lebanese University, Rafic Hariri Educational Campus, Hadat, Lebanon; Department of Pharmacy, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Bart J F van den Bemt
- Department of Pharmacy, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pharmacy, Sint Maartenskliniek, Nijmegen, the Netherlands; Department of Pharmacy, University Medical Center Maastricht, Maastricht, the Netherlands
| | - Ayman Jaber
- Department of Cardiology, Mount Lebanon Hospital - University Medical Center, Beirut, Lebanon
| | - Mazen Kurdi
- Laboratory of Experimental and Clinical Pharmacology, Faculty of Sciences, Section 1, Lebanese University, Rafic Hariri Educational Campus, Hadat, Lebanon.
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Grandperrin A, Schuster I, Moronval P, Izem O, Rupp T, Obert P, Nottin S. Anabolic Steroids Use Is Associated with Impairments in Atrial and Ventricular Cardiac Structure and Performance in Athletes. Med Sci Sports Exerc 2022; 54:780-788. [PMID: 34974501 DOI: 10.1249/mss.0000000000002852] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Despite potential severe cardiac side effects, anabolic androgenic steroids (AAS) are increasingly used by strength athletes. However, previous echocardiographic studies focused on the left ventricular (LV) strains but did not assess LV twist and untwist mechanics. Moreover, left atrial (LA) function has been often neglected, and its stiffness, an important determinant of LA reservoir function, has never been challenged. The aim of this study was to investigate the effects of AAS on LA and LV morphologies and functions in strength athletes. METHODS Fifty subjects including 20 strength-trained young athletes age 32.0 ± 8.5 yr with a mean duration of AAS use of 4.7 ± 1.8 yr (users), 15 athletes with no history of AAS use (nonusers) and 15 sedentary controls underwent speckle tracking echocardiography to assess LA and LV morphology and function. RESULTS Users showed higher LA reservoir dysfunction than nonusers (33.7% ± 10.9% vs 44.9% ± 9.9% respectively, P = 0.004) and higher LA stiffness (0.13 ± 0.05 vs 0.19 ± 0.08 A.U., respectively; P = 0.02), higher LV mass index and lower global and regional LV diastolic and systolic dysfunction (global longitudinal strain: -15.5% ± 3.2% vs -18.9% ± 1.8% respectively; P = 0.003), with a drop of LV twist-untwist mechanics (untwisting velocity: 61.5°·s-1 ± 20.2°·s-1 vs 73.7°·s-1 ± 16.1°·s-1 respectively, P = 0.04). There were significant correlations between LV mass and LV apical rotation (P = 0.003, r = 0.44) and diastolic longitudinal strain rate (P = 0.015, r = 0.33). CONCLUSIONS Our results showing significant LA and LV remodeling and dysfunctions in young AAS using athletes are alarming. Screening echocardiography based on speckle tracking echocardiography parameters for early diagnosis, as well as a stronger awareness in athletes and in physicians are warranted in this context.
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Affiliation(s)
| | | | | | | | - Thomas Rupp
- LIBM, Inter-University Laboratory of Human Movement Science, University Savoie Mont Blanc, Chambéry, FRANCE
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Abbasnezhad A, Mahdavi M, Kianmehr M, Ghorbani M, Motaghy MR, Sohrabi M, Hajavi J. The effects of anabolic-androgenic steroids on DNA damage in bodybuilders' blood lymphocytes. Biomarkers 2021; 26:685-690. [PMID: 34472401 DOI: 10.1080/1354750x.2021.1976837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Nowadays bodybuilders use anabolic steroids frequently. Abuse of these substances can cause significant side effects; therefore, we aim to investigate the effect of anabolic steroids on DNA damage in bodybuilders' blood lymphocytes. METHODS AND MATERIALS This case-control study was performed on 36 male bodybuilders in Gonabad. The case group included bodybuilders with a history of taking anabolic-androgenic steroids (n = 18), and the control group composed of bodybuilders who did not use anabolic-androgenic steroids (n = 18). Intravenous blood samples were obtained and then the lymphocytes, cells and electrophoresis of blood were extracted. Afterward, the coloured slides and DNA damage were measured using a fluorescent microscope and CometScore software. The DNA damage was compared using t-tests . RESULTS Results showed that there was no significant difference between age, marital status, BMI, systolic and diastolic blood pressure in the case and control group. However, parameters related to the DNA damage including tail length, percent tail DNA, and tail moment were significantly higher in the case group. CONCLUSION The use of anabolic-androgenic steroids increases DNA damage in the bodybuilders' blood lymphocytes.
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Affiliation(s)
- Abbasali Abbasnezhad
- Department of Physiology, Faculty of Medicine, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Miad Mahdavi
- Faculty of Medicine, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Mojtaba Kianmehr
- Department of Medical Physics, Faculty of Medicine, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Mohamad Ghorbani
- Department of Hematology, Faculty of Medicine, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Mahmoud Reza Motaghy
- Department of Basic Sciences, Faculty of Medicine, Infectious Diseases Research Center, Gonabad University of Medical Science, Gonabad, Iran
| | - Mohammad Sohrabi
- Faculty of Medicine, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Jafar Hajavi
- Department of Basic Sciences, Faculty of Medicine, Infectious Diseases Research Center, Gonabad University of Medical Science, Gonabad, Iran
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de Souza FR, Dos Santos MR, Rochitte CE, Dos Santos RP, Jordão CP, Leite IS, da Fonseca GWP, Fonseca RA, de Oliveira TF, Yonamine M, Pereira RMR, Negrão CE, Alves DNNMJ. Decreased Native T1 Values and Impaired Myocardial Contractility in Anabolic Steroid Users. Int J Sports Med 2021; 43:183-191. [PMID: 34341973 DOI: 10.1055/a-1518-7953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Anabolic androgenic steroid (AAS) abuse leads to myocardial toxicity. Human studies are conflicting about the myocardial fibrosis in AAS users. We evaluated cardiac tissue characterization, left ventricle (LV) function, and cardiac structure by cardiovascular magnetic resonance (CMR). Twenty strength-trained AAS users (AASU) aged 29±5 yr, 20 strength-trained AAS nonusers (AASNU), and 7 sedentary controls (SC) were enrolled. Native T1 mapping, late-gadolinium enhancement (LGE), extracellular volume (ECV), and myocardial strain were evaluated. AASU showed lower Native T1 values than AASNU (888±162 vs. 1020±179 ms p=0.047). Focal myocardial fibrosis was found in 2 AASU. AASU showed lower LV radial strain (30±8 vs. 38±6%, p<0.01), LV circumferential strain (-17±3 vs. -20±2%, p<0.01), and LV global longitudinal strain (-17±3 vs. -20±3%, p<0.01) than AASNU by CMR. By echocardiography, AASU demonstrated lower 4-chamber longitudinal strain than AASNU (-15±g3 vs. -18±2%, p=0.03). ECV was similar among AASU, AASNU, and SC (28±10 vs. 28±7 vs. 30±7%, p=0.93). AASU had higher LV mass index than AASNU and SC (85±14 vs. 64±8 vs. 58±5 g/m2, respectively, p<0.01). AAS abuse may be linked to decreased myocardial native T1 values, impaired myocardial contractility, and focal fibrosis. These alterations may be associated with maladaptive cardiac hypertrophy in young AAS users.
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Affiliation(s)
- Francis Ribeiro de Souza
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Marcelo Rodrigues Dos Santos
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Carlos Eduardo Rochitte
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Rafael Parenquine Dos Santos
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Camila Paixão Jordão
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Ivanhoe Stuart Leite
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Rafael Almeida Fonseca
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Tiago Franco de Oliveira
- Departamento de Farmacociências da Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
| | - Maurício Yonamine
- Departamento de Análises Clínicas e Toxicológicas da Faculdade de Ciências Farmacêuticas da Universidade de São Paulo, São Paulo, Brazil
| | - Rosa Maria Rodrigues Pereira
- Laboratório de Metabolismo Ósseo, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Carlos Eduardo Negrão
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Escola de Educação Física e Esporte da Universidade de São Paulo, São Paulo, Brazil
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Gastl M, Lachmann V, Christidi A, Janzarik N, Veulemans V, Haberkorn S, Holzbach L, Jacoby C, Schnackenburg B, Berrisch-Rahmel S, Zeus T, Kelm M, Bönner F. Cardiac magnetic resonance T2 mapping and feature tracking in athlete's heart and HCM. Eur Radiol 2020; 31:2768-2777. [PMID: 33063183 PMCID: PMC8043946 DOI: 10.1007/s00330-020-07289-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 08/17/2020] [Accepted: 09/11/2020] [Indexed: 12/21/2022]
Abstract
Objectives Distinguishing hypertrophic cardiomyopathy (HCM) from left ventricular hypertrophy (LVH) due to systematic training (athlete’s heart, AH) from morphologic assessment remains challenging. The purpose of this study was to examine the role of T2 mapping and deformation imaging obtained by cardiovascular magnetic resonance (CMR) to discriminate AH from HCM with (HOCM) or without outflow tract obstruction (HNCM). Methods Thirty-three patients with HOCM, 9 with HNCM, 13 strength-trained athletes as well as individual age- and gender-matched controls received CMR. For T2 mapping, GRASE-derived multi-echo images were obtained and analyzed using dedicated software. Besides T2 mapping analyses, left ventricular (LV) dimensional and functional parameters were obtained including LV mass per body surface area (LVMi), interventricular septum thickness (IVS), and global longitudinal strain (GLS). Results While LVMi was not significantly different, IVS was thickened in HOCM patients compared to athlete’s. Absolute values of GLS were significantly increased in patients with HOCM/HNCM compared to AH. Median T2 values were elevated compared to controls except in athlete’s heart. ROC analysis revealed T2 values (AUC 0.78) and GLS (AUC 0.91) as good parameters to discriminate AH from overall HNCM/HOCM. Conclusion Discrimination of pathologic from non-pathologic LVH has implications for risk assessment of competitive sports in athletes. Multiparametric CMR with parametric T2 mapping and deformation imaging may add information to distinguish AH from LVH due to HCM. Key Points • Structural analyses using T2 mapping cardiovascular magnetic resonance imaging (CMR) may help to further distinguish myocardial diseases. • To differentiate pathologic from non-pathologic left ventricular hypertrophy, CMR including T2 mapping was obtained in patients with hypertrophic obstructive/non-obstructive cardiomyopathy (HOCM/HNCM) as well as in strength-trained athletes. • Elevated median T2 values in HOCM/HNCM compared with athlete’s may add information to distinguish athlete’s heart from pathologic left ventricular hypertrophy.
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Affiliation(s)
- Mareike Gastl
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Moorenstraße 5, Düsseldorf, 40225, Germany.
| | - Vera Lachmann
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Moorenstraße 5, Düsseldorf, 40225, Germany
| | - Aikaterini Christidi
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Moorenstraße 5, Düsseldorf, 40225, Germany
| | - Nico Janzarik
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Moorenstraße 5, Düsseldorf, 40225, Germany
| | - Verena Veulemans
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Moorenstraße 5, Düsseldorf, 40225, Germany
| | - Sebastian Haberkorn
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Moorenstraße 5, Düsseldorf, 40225, Germany
| | - Leonie Holzbach
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Moorenstraße 5, Düsseldorf, 40225, Germany
| | - Christoph Jacoby
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Moorenstraße 5, Düsseldorf, 40225, Germany
| | | | - Susanne Berrisch-Rahmel
- KardioPro, Praxis für Innere Medizin, Kardiologie, Sport Medizin und Sportkardiologie, Düsseldorf, Germany
| | - Tobias Zeus
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Moorenstraße 5, Düsseldorf, 40225, Germany
| | - Malte Kelm
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Moorenstraße 5, Düsseldorf, 40225, Germany.,CARID (Cardiovascular Research Institute Düsseldorf), Düsseldorf, Germany
| | - Florian Bönner
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Moorenstraße 5, Düsseldorf, 40225, Germany
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Lycopene protects against renal cortical damage induced by nandrolone decanoate in adult male rats. Ann Anat 2019; 224:142-152. [DOI: 10.1016/j.aanat.2019.05.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 05/02/2019] [Accepted: 05/03/2019] [Indexed: 01/28/2023]
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9
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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: 23] [Impact Index Per Article: 4.6] [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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10
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Chaudhari S, Cushen SC, Osikoya O, Jaini PA, Posey R, Mathis KW, Goulopoulou S. Mechanisms of Sex Disparities in Cardiovascular Function and Remodeling. Compr Physiol 2018; 9:375-411. [PMID: 30549017 DOI: 10.1002/cphy.c180003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Epidemiological studies demonstrate disparities between men and women in cardiovascular disease prevalence, clinical symptoms, treatments, and outcomes. Enrollment of women in clinical trials is lower than men, and experimental studies investigating molecular mechanisms and efficacy of certain therapeutics in cardiovascular disease have been primarily conducted in male animals. These practices bias data interpretation and limit the implication of research findings in female clinical populations. This review will focus on the biological origins of sex differences in cardiovascular physiology, health, and disease, with an emphasis on the sex hormones, estrogen and testosterone. First, we will briefly discuss epidemiological evidence of sex disparities in cardiovascular disease prevalence and clinical manifestation. Second, we will describe studies suggesting sexual dimorphism in normal cardiovascular function from fetal life to older age. Third, we will summarize and critically discuss the current literature regarding the molecular mechanisms underlying the effects of estrogens and androgens on cardiac and vascular physiology and the contribution of these hormones to sex differences in cardiovascular disease. Fourth, we will present cardiovascular disease risk factors that are positively associated with the female sex, and thus, contributing to increased cardiovascular risk in women. We conclude that inclusion of both men and women in the investigation of the role of estrogens and androgens in cardiovascular physiology will advance our understanding of the mechanisms underlying sex differences in cardiovascular disease. In addition, investigating the role of sex-specific factors in the development of cardiovascular disease will reduce sex and gender disparities in the treatment and diagnosis of cardiovascular disease. © 2019 American Physiological Society. Compr Physiol 9:375-411, 2019.
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Affiliation(s)
- Sarika Chaudhari
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Spencer C Cushen
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Oluwatobiloba Osikoya
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Paresh A Jaini
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Rachel Posey
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Keisa W Mathis
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Styliani Goulopoulou
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
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11
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Angell P, Green D, Lord R, Gaze D, Whyte G, George K. Acute cardiovascular responses to resistance exercise in anabolic steroids users: A preliminary investigation. Sci Sports 2018. [DOI: 10.1016/j.scispo.2018.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Rasmussen JJ, Schou M, Madsen PL, Selmer C, Johansen ML, Ulriksen PS, Dreyer T, Kümler T, Plesner LL, Faber J, Gustafsson F, Kistorp C. Cardiac systolic dysfunction in past illicit users of anabolic androgenic steroids. Am Heart J 2018; 203:49-56. [PMID: 30015068 DOI: 10.1016/j.ahj.2018.06.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 06/17/2018] [Indexed: 01/20/2023]
Abstract
Background Illicit use of anabolic androgenic steroids (AAS) is associated with left ventricle (LV) systolic dysfunction and increased LV mass (LVM), but whether these findings persist in former AAS users has yet to be elucidated. The objective was to assess LV systolic function, LVM and myocardial fibrosis in current and former illicit AAS users compared with non-users. Methods Community-based cross-sectional study among men, aged 18–50 years, involved in recreational resistance training. We included 37 current and 33 former illicit AAS users, geometric mean (95%CI), 30 (21; 44) months since AAS cessation, and 30 non-users as controls. We assessed myocardial function and structure using advanced echocardiography and cardiac MRI with late-gadolinium enhancement. Results Mean (SE) LV global longitudinal strain (GLS) was impaired in former AAS users compared with non-users, −16.7 (0.5) versus −18.2 (0.4) %, P < .05. Mean (SE) LV ejection fraction (EF) was decreased, 51 (1) versus 58 (1) %, P < .001 and LV GLS impaired, −14.5 (0.4)%, P < .001, in current AAS users compared with non-users. Measures of LVM were increased in current AAS users compared with the other two groups, P < .001. Plasma total testosterone was independently associated with reduced LVEF (P = .049) and increased LVM/body surface area (P = .005) in multivariate linear regressions. Focal myocardial fibrosis was not detected in any participants and diffuse myocardial fibrosis, assessed using post-contrast T1-mapping time, did not differ among the three groups. Conclusions Past illicit AAS use is associated with impaired LV GLS, suggesting subclinical cardiac systolic dysfunction years after AAS cessation.
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Affiliation(s)
- Jon J Rasmussen
- Centre of Endocrinology and Metabolism, Department of Internal Medicine, Copenhagen University Hospitals Herlev/Gentofte, Herlev, Denmark; Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Morten Schou
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Cardiology, Copenhagen University Hospitals Herlev/Gentofte, Herlev, Denmark
| | - Per L Madsen
- Department of Cardiology, Copenhagen University Hospitals Herlev/Gentofte, Herlev, Denmark
| | - Christian Selmer
- Centre of Endocrinology and Metabolism, Department of Internal Medicine, Copenhagen University Hospitals Herlev/Gentofte, Herlev, Denmark
| | - Marie L Johansen
- Centre of Endocrinology and Metabolism, Department of Internal Medicine, Copenhagen University Hospitals Herlev/Gentofte, Herlev, Denmark; Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Peter S Ulriksen
- Department of Radiology, Copenhagen University Hospitals, Herlev/Gentofte, Herlev, Denmark
| | - Tina Dreyer
- Centre of Endocrinology and Metabolism, Department of Internal Medicine, Copenhagen University Hospitals Herlev/Gentofte, Herlev, Denmark
| | - Thomas Kümler
- Department of Cardiology, Copenhagen University Hospitals Herlev/Gentofte, Herlev, Denmark
| | - Louis L Plesner
- Department of Cardiology, Copenhagen University Hospitals Herlev/Gentofte, Herlev, Denmark
| | - Jens Faber
- Centre of Endocrinology and Metabolism, Department of Internal Medicine, Copenhagen University Hospitals Herlev/Gentofte, Herlev, Denmark; Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Finn Gustafsson
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Cardiology, Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Caroline Kistorp
- Centre of Endocrinology and Metabolism, Department of Internal Medicine, Copenhagen University Hospitals Herlev/Gentofte, Herlev, Denmark; Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Tsioufis C. "Hearts that strain": Distinguishing athlete's heart from hypertensive disease in the echo lab and beyond. Hellenic J Cardiol 2018; 59:189-191. [PMID: 29964160 DOI: 10.1016/j.hjc.2018.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 06/04/2018] [Indexed: 01/20/2023] Open
Abstract
Individuals with hypertension that engage in regular exercise comprise a special patient group that needs a careful approach to differentiate hypertensive cardiac damage from physiologic cardiac adaptations. Echocardiography is the diagnostic modality of choice in such cases. Hypertensive left ventricular hypertrophy is expected to resemble isometric exercise-associated hypertrophy in some but not all cases. On the other side, the hearts of regularly exercising individuals are expected to be normal or present with a variable mix of increased end-diastolic volume and increased wall thickness. It is therefore important to clearly document the type, frequency and duration of exercise performed. Diastolic dysfunction even without hypertrophy is often the first and only presentation in hypertension. On the contrary, diastolic function in athletes may be enhanced in order to maintain a stroke volume in high heart rates. Novel imaging techniques such as global longitudinal strain are helpful to identify subclinical systolic dysfunction that is inconsistent with athletic cardiac changes.
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Affiliation(s)
- Costas Tsioufis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece.
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Left Ventricular Speckle Tracking-Derived Cardiac Strain and Cardiac Twist Mechanics in Athletes: A Systematic Review and Meta-Analysis of Controlled Studies. Sports Med 2018; 47:1145-1170. [PMID: 27889869 PMCID: PMC5432587 DOI: 10.1007/s40279-016-0644-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background The athlete’s heart is associated with physiological remodeling as a consequence of repetitive cardiac loading. The effect of exercise training on left ventricular (LV) cardiac strain and twist mechanics are equivocal, and no meta-analysis has been conducted to date. Objective The objective of this systematic review and meta-analysis was to review the literature pertaining to the effect of different forms of athletic training on cardiac strain and twist mechanics and determine the influence of traditional and contemporary sporting classifications on cardiac strain and twist mechanics. Methods We searched PubMed/MEDLINE, Web of Science, and ScienceDirect for controlled studies of aged-matched male participants aged 18–45 years that used two-dimensional (2D) speckle tracking with a defined athlete sporting discipline and a control group not engaged in training programs. Data were extracted independently by two reviewers. Random-effects meta-analyses, subgroup analyses, and meta-regressions were conducted. Results Our review included 13 studies with 945 participants (controls n = 355; athletes n = 590). Meta-analyses showed no athlete–control differences in LV strain or twist mechanics. However, moderator analyses showed greater LV twist in high-static low-dynamic athletes (d = –0.76, 95% confidence interval [CI] –1.32 to –0.20; p < 0.01) than in controls. Peak untwisting velocity (PUV) was greater in high-static low-dynamic athletes (d = –0.43, 95% CI –0.84 to –0.03; p < 0.05) but less than controls in high-static high-dynamic athletes (d = 0.79, 95% CI 0.002–1.58; p = 0.05). Elite endurance athletes had significantly less twist and apical rotation than controls (d = 0.68, 95% CI 0.19–1.16, p < 0.01; d = 0.64, 95% CI 0.27–1.00, p = 0.001, respectively) but no differences in basal rotation. Meta-regressions showed LV mass index was positively associated with global longitudinal (b = 0.01, 95% CI 0.002–0.02; p < 0.05), whereas systolic blood pressure was negatively associated with PUV (b = –0.06, 95% CI –0.13 to –0.001; p = 0.05). Conclusion Echocardiographic 2D speckle tracking can identify subtle physiological differences in adaptations to cardiac strain and twist mechanics between athletes and healthy controls. Differences in speckle tracking echocardiography-derived parameters can be identified using suitable sporting categorizations.
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Use of anabolic androgenic steroids produces greater oxidative stress responses to resistance exercise in strength-trained men. Toxicol Rep 2017; 4:282-286. [PMID: 28959650 PMCID: PMC5615127 DOI: 10.1016/j.toxrep.2017.05.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 05/22/2017] [Accepted: 05/25/2017] [Indexed: 12/30/2022] Open
Abstract
Single session of high-intensity RE on trained bodybuilder men had effect on DNA damage and oxidative stress. The AAS users showed greater response than NAAS users. At pre-RE, the levels of oxidant were greater for the AAS group. The study has reported a range of negative redox status consequence of AAS use in conjunction with resistance training. The alteration of oxidative stress status with AAS use likely increase the injury risks in some organs in athletes.
The aim of this study was to determine the effect of anabolic androgenic steroids (AAS) use on oxidative stress responses to a single session of resistance exercise in strength-trained men. Twenty-three strength trained men, with 11 self-reporting regular AAS use and 12 self-reporting never taking AAS (NAAS) volunteered to participate in this study. Blood draws were obtained pre and post resistance exercise in order to evaluate changes in oxidative stress biomarkers levels (i.e., 8-hydroxy-2-deoxyguanosine [8-OHdG], malondialdehyde [MDA], and nitric oxide [NO]), antioxidant defense systems (i.e., glutathione peroxidase [GPx] and catalase [CAT]), and glucose (GLU) levels. The AAS users had higher level of 8-OHdG (77.3 ± 17 vs. 57.7 ± 18.2 ng/mg), MDA (85.6 ± 17.8 vs. 52.3 ± 15.1 ng/mL), and GPx (9.1 ± 2.3 vs. 7.1 ± 1.3 mu/mL) compared to NAAS at pre exercise (p < 0.05). Both the experimental groups showed increases in 8-OHdG (p = 0.001), MDA (p = 0.001), GPx (p = 0.001), NO (p = 0.04), CAT (p = 0.02) and GLU (p = 0.001) concentrations after resistance exercise, and the AAS group indicated significant differences in 8-OHdG (p = 0.02) and MDA (p = 0.05) concentrations compared with NAAS users at post exercise. In conclusion, use of AAS is associated with alterations in immune function resulting in oxidative stress, and cell damage; however, high-intensity resistance exercise could increase greater oxidative stress biomarkers in strength-trained men.
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16
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Galderisi M, Cardim N, D'Andrea A, Bruder O, Cosyns B, Davin L, Donal E, Edvardsen T, Freitas A, Habib G, Kitsiou A, Plein S, Petersen SE, Popescu BA, Schroeder S, Burgstahler C, Lancellotti P. The multi-modality cardiac imaging approach to the Athlete's heart: an expert consensus of the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2016; 16:353. [PMID: 25681828 DOI: 10.1093/ehjci/jeu323] [Citation(s) in RCA: 156] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The term 'athlete's heart' refers to a clinical picture characterized by a slow heart rate and enlargement of the heart. A multi-modality imaging approach to the athlete's heart aims to differentiate physiological changes due to intensive training in the athlete's heart from serious cardiac diseases with similar morphological features. Imaging assessment of the athlete's heart should begin with a thorough echocardiographic examination.Left ventricular (LV) wall thickness by echocardiography can contribute to the distinction between athlete's LV hypertrophy and hypertrophic cardiomyopathy (HCM). LV end-diastolic diameter becomes larger (>55 mm) than the normal limits only in end-stage HCM patients when the LV ejection fraction is <50%. Patients with HCM also show early impairment of LV diastolic function, whereas athletes have normal diastolic function.When echocardiography cannot provide a clear differential diagnosis, cardiac magnetic resonance (CMR) imaging should be performed.With CMR, accurate morphological and functional assessment can be made. Tissue characterization by late gadolinium enhancement may show a distinctive, non-ischaemic pattern in HCM and a variety of other myocardial conditions such as idiopathic dilated cardiomyopathy or myocarditis. The work-up of athletes with suspected coronary artery disease should start with an exercise ECG. In athletes with inconclusive exercise ECG results, exercise stress echocardiography should be considered. Nuclear cardiology techniques, coronary cardiac tomography (CCT) and/or CMR may be performed in selected cases. Owing to radiation exposure and the young age of most athletes, the use of CCT and nuclear cardiology techniques should be restricted to athletes with unclear stress echocardiography or CMR.
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MESH Headings
- Adult
- Arrhythmogenic Right Ventricular Dysplasia/diagnosis
- Cardiac Imaging Techniques/methods
- Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography
- Cardiomegaly/diagnosis
- Cardiomegaly, Exercise-Induced
- Cardiomyopathy, Dilated/diagnosis
- Cardiomyopathy, Hypertrophic/diagnosis
- Consensus
- Contrast Media
- Death, Sudden, Cardiac/prevention & control
- Echocardiography, Stress/methods
- Electrocardiography
- European Union
- Gadolinium
- Humans
- Hypertrophy, Left Ventricular/diagnosis
- Magnetic Resonance Imaging, Cine
- Predictive Value of Tests
- Sensitivity and Specificity
- Societies, Medical
- Technetium Tc 99m Sestamibi
- Tomography, Emission-Computed, Single-Photon
- Tomography, X-Ray Computed/methods
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17
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Testosterone may influence left ventricular diastolic function depending on previous myocardial infarction and smoking. Int J Cardiol 2015; 186:67-71. [DOI: 10.1016/j.ijcard.2015.03.238] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 03/17/2015] [Indexed: 12/16/2022]
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18
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Ayaz O, Howlett SE. Testosterone modulates cardiac contraction and calcium homeostasis: cellular and molecular mechanisms. Biol Sex Differ 2015; 6:9. [PMID: 25922656 PMCID: PMC4411792 DOI: 10.1186/s13293-015-0027-9] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 03/27/2015] [Indexed: 02/06/2023] Open
Abstract
The incidence of cardiovascular disease rises dramatically with age in both men and women. Because a woman's risk of cardiovascular disease rises markedly after the onset of menopause, there has been growing interest in the effect of estrogen on the heart and its role in the pathophysiology of these diseases. Much less attention has been paid to the impact of testosterone on the heart, even though the levels of testosterone also decline with age and low-testosterone levels are linked to the development of cardiovascular diseases. The knowledge that receptors for all major sex steroid hormones, including testosterone, are present on individual cardiomyocytes suggests that these hormones may influence the heart at the cellular level. Indeed, it is well established that there are male-female differences in intracellular Ca(2+) release and contraction in isolated ventricular myocytes. Growing evidence suggests that these differences arise from effects of sex steroid hormones on processes involved in intracellular Ca(2+) homeostasis. This review considers how myocardial contractile function is modified by testosterone, with a focus on the impact of testosterone on processes that regulate Ca(2+) handling at the level of the ventricular myocyte. The idea that testosterone regulates Ca(2+) handling in the heart is important, as Ca(2+) dysregulation plays a key role in the pathogenesis of a variety of different cardiovascular diseases. A better understanding of sex hormone regulation of myocardial Ca(2+) homeostasis may reveal new targets for the treatment of cardiovascular diseases in all older adults.
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Affiliation(s)
- Omar Ayaz
- Department of Pharmacology, Dalhousie University, 5850 College Street, Sir Charles Tupper Medical Building, PO Box 15000, Halifax, NS B3H 4R2 Canada
| | - Susan Ellen Howlett
- Department of Pharmacology, Dalhousie University, 5850 College Street, Sir Charles Tupper Medical Building, PO Box 15000, Halifax, NS B3H 4R2 Canada
- Medicine (Geriatric Medicine), Dalhousie University, 5850 College Street, PO Box 15000, Halifax, NS B3H 4R2 Canada
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Granados J, Gillum TL, Christmas KM, Kuennen MR. Prohormone supplement 3β-hydroxy-5α-androst-1-en-17-one enhances resistance training gains but impairs user health. J Appl Physiol (1985) 2014; 116:560-9. [DOI: 10.1152/japplphysiol.00616.2013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Prohormone supplements (PS) are recognized not to impart anabolic or ergogenic effects in men, but the research supporting these conclusions is dated. The Anabolic Steroid Control Act was amended in 2004 to classify androstenedione and 17 additional anabolic compounds as controlled substances. The viability of PS that entered the market after that time have not been evaluated. Seventeen resistance-trained men (23 ± 1 yr; 13.1 ± 1.5% body fat) were randomly assigned to receive either 330 mg/day of 3β-hydroxy-5α-androst-1-en-17-one (Prohormone; n = 9) or sugar (Placebo; n = 8) per os and complete a 4-wk (16 session) structured resistance-training program. Body composition, muscular strength, circulating lipids, and markers of liver and kidney dysfunction were assessed at study onset and termination. Prohormone increased lean body mass by 6.3 ± 1.2%, decreased fat body mass by 24.6 ± 7.1%, and increased their back squat one repetition maximum and competition total by 14.3 ± 1.5 and 12.8 ± 1.1%, respectively. These improvements exceeded ( P < 0.05) Placebo, which increased lean body mass by 0.5 ± 0.8%, reduced fat body mass by 9.5 ± 3.6%, and increased back squat one repetition maximum and competition total by 5.7 ± 1.7 and 5.9 ± 1.7%, respectively. Prohormone also experienced multiple adverse effects. These included a 38.7 ± 4.0% reduction in HDL ( P < 0.01), a 32.8 ± 15.05% elevation in LDL ( P < 0.01), and elevations of 120.0 ± 22.6 and 77.4 ± 12.0% in LDL-to-HDL and cholesterol-to-HDL ratios, respectively (both P < 0.01). Prohormone also exhibited elevations in serum creatinine (19.6 ± 4.3%; P < 0.01) and aspartate transaminase (113.8 ± 61.1%; P = 0.05), as well as reductions in serum albumin (5.1 ± 1.9%; P = 0.04), alkaline phosphatase (16.4 ± 4.7%; P = 0.04), and glomerular filtration rate (18.0 ± 3.3%; P = 0.04). None of these values changed (all P > 0.05) in Placebo. The oral PS 3β-hydroxy-5α-androst-1-en-17-one improves body composition and muscular strength. However, these changes come at a significant cost. Cardiovascular health and liver function are particularly compromised. Given these findings, we feel the harm associated with this particular PS outweighs any potential benefit.
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Affiliation(s)
- Jorge Granados
- Human Performance Research Laboratories, West Texas A&M University, Canyon, Texas
| | - Trevor L. Gillum
- Department of Kinesiology, California Baptist University, Riverside, California; and
| | - Kevin M. Christmas
- Department of Kinesiology & Health Education, The University of Texas at Austin, Austin, Texas
| | - Matthew R. Kuennen
- Human Performance Research Laboratories, West Texas A&M University, Canyon, Texas
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Angell PJ, Ismail TF, Jabbour A, Smith G, Dahl A, Wage R, Whyte G, Green DJ, Prasad S, George K. Ventricular structure, function, and focal fibrosis in anabolic steroid users: a CMR study. Eur J Appl Physiol 2014; 114:921-8. [PMID: 24463601 DOI: 10.1007/s00421-014-2820-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 01/08/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE Anabolic steroid (AS) misuse is widespread amongst recreational bodybuilders; however, their effects on the cardiovascular system are uncertain. Our aim was to document the impact of AS use on cardiac structure, function and the presence of focal fibrosis using the gold standard cardiovascular magnetic resonance imaging (CMR). METHODS A cross-sectional cohort design was utilised with 21 strength-trained participants who underwent CMR imaging of the heart and speckle-tracking echocardiography. Thirteen participants (30 ± 5 years) taking AS for at least 2 years and currently on a "using"-cycle were compared with age and training-matched controls (n = 8; 29 ± 6 years) who self-reported never having taken AS (NAS). RESULTS AS users had higher absolute left ventricular (LV) mass (220 ± 45 g) compared to NAS (163 ± 27 g; p < 0.05) but this difference was removed when indexed to fat-free mass. AS had a reduced right ventricular (RV) ejection fraction (AS 51 ± 4 % vs. NAS 59 ± 5 %; p < 0.05) and a significantly lower left ventricular E':A' myocardial tissue velocity ratio [AS 0.99(0.54) vs. NAS 1.78(0.46) p < 0.05] predominantly due to greater tissue velocities with atrial contraction. Peak LV longitudinal strain was lower in AS users (AS -14.2 ± 2.7 % vs. NAS -16.6 ± 1.9 %; p < 0.05). There was no evidence of focal fibrosis in any participant. CONCLUSIONS AS use was associated with significant LV hypertrophy, albeit in-line with greater fat-free mass, reduced LV strain, diastolic function, and reduced RV ejection fraction in male bodybuilders. There was, however, no evidence of focal fibrosis in any AS user.
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Affiliation(s)
- Peter J Angell
- Health Sciences Department, Liverpool Hope University, Hope Park, Liverpool, L16 9JD, UK,
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Abstract
The objectives of this article were to review the anabolic androgen steroids, specifically the direct and indirect effects on the cardiovascular system of the individuals who use them, and to summarize the evidence regarding the effects of androgens on the cardiovascular system. A search of the English-language scientific literature from 1976 to March 2012 was performed primarily by searching the MEDLINE and Embase databases and Google. Anabolic androgenic steroids are associated with direct effects such as cardiac muscle hypertrophy and myocardial fibrosis and indirect effects, including dyslipidemia, hypertension, arrhythmia, and myocardial infarction. It is likely that chronic exposure to these agents can result in significant alterations in the cardiovascular system, and their safety has not been fully established.
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