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Int J Sports Med 2003; 24(5): 337-343
DOI: 10.1055/s-2003-40702
Physiology & Biochemistry
© Georg Thieme Verlag Stuttgart · New York

Anabolic Androgenic Steroids Produce Dose-Dependent Increase in Left Ventricular Mass in Power Athletes, and this Effect is Potentiated by Concomitant Use of Growth Hormone

T. A. M. Karila1, 2, 3 , J. E.  Karjalainen4 , M. J.  Mäntysaari4 , M. T.  Viitasalo5 , T. A.  Seppälä1, 2
  • 1Laboratory of Substance Abuse, National Public Health Institute, Helsinki, Finland
  • 2Department of Pharmacology and Toxicology, Institute of Biomedicine, University of Helsinki, Finland
  • 3Department of Orthopaedics and Traumatology, Helsinki University Central Hospital, Finland
  • 4Central Military Hospital and Research Institute of Military Medicine, Helsinki, Finland
  • 5Department of Internal Medicine, Helsinki University Central Hospital, Finland
Further Information

Publication History

Accepted after revision: January 15, 2003

Publication Date:
17 July 2003 (online)

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Abstract

Power athletes abuse anabolic androgenic steroids (AASs) and growth hormone (GH) to gain their muscular mass and strength. We wanted to determine how massive, self-administered doses of AASs with or without GH affect the left ventricular (LV) dimensions in power athletes. These substances are assumed to increase LVmass mainly by thickening the ventricular walls. Anecdotal evidence suggests a higher risk of cardiovascular events in AAS abusers. We were interested to see if LV dimensions and function in AAS abusers would indicate this increased risk. Twenty healthy male power athletes using massive doses of AAS without (n = 16) or with (n = 4) GH volunteered for the study. The controls were 15 sedentary male non-users of hormones. LV mass, geometry and filling were studied using standard echocardiographic methods. We found a significant association between LV mass and AAS dose (r = 0.54, p < 0.015). In contrast to the controls, LV mass (274 g in the athletes, 167 g in the controls) among the AAS abusers did not correlate with body weight or height. Concomitant use of AAS and GH further increased LV mass and associated with concentric remodelling of LV. Multiple regression analysis indicated that the mean AAS dose accounted for 29 %, age for 14 % and systolic blood pressure for 17 % of the variance in LV mass. We concluded that AAS abuse associates dose-dependently with myocardial hypertrophy and that concomitant use of GH associates with concentric remodelling of the LV. Our findings suggest that AASs and GH have a direct effect on the myocardium.

Key words

Substance abuse - left ventricular hypertrophy

References

  • 1 Behrent H, Boffin H. Myocardial cell lesions caused by anabolic hormone.  Cell Tissue Res. 1977;  181 423-426
    PubMedGoogle Scholar
  • 2 Bhasin S, Storer T W, Berman N, Callegari C, Clevenger B, Phillips J, Bunnell T J, Tricker R, Shirazi A, Casaburi R. The effects of supraphysiologic doses of testosterone on muscle size and strength in normal men.  N Engl J Med. 1996;  335 1-7
    CrossrefPubMedGoogle Scholar
  • 3 Caidahl K, Edén S, Bengtsson B Å. Cardiovascular and renal effects of growth hormone.  Clin Endoc. 1994;  40 393-400
    PubMedGoogle Scholar
  • 4 Deligiannis A P, Mandroukas K. Noninvasive cardiac evaluation of weightlifters using anabolic steroids.  Scand J Med Sci Sports. 1992;  3 37-40
    PubMedGoogle Scholar
  • 5 de Piccoli B, Giada F, Benettin A, Sartori F, Piccolo E. Anabolic steroid use in body builders: an echocardiographic study of left ventricular morphology and function.  Int J Sports Med. 1991;  12 408-412
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Devereux R B. Detection of left ventricular hypertrophy by M-mode echocardiography.  Hypertension. 1987;  9(suppl II) 19-26
    PubMedGoogle Scholar
  • 7 Dickerman R D, Schaller F, McConathy W J. Left ventricular wall thickening does occur in elite power athletes with or without anabolic steroid use.  Cardiology. 1998;  90 145-148
    CrossrefPubMedGoogle Scholar
  • 8 Dickerman R D, Schaller F, Zachariah N Y, McConathy W J. Left ventricular size and function in elite bodybuilders using anabolic steroids.  Clin J Sport Med. 1997;  7 90-93
    CrossrefPubMedGoogle Scholar
  • 9 Donike M, Geyer H, Gotzmann A, Kraft M, Mandel F, Nolteernsting E, Opfermann G, Sigmund G, Schänzer W, Zimmermann J. Dope Analysis. Official Proceedings of International Athletic Foundation World Symposium on Doping in Sport - 1987. In Bellotti P, Benzi G, Ljungqist A, ed London; Published by the International Athletic Foundation 1988: 53-80
    Google Scholar
  • 10 Fazio S, Sabatini D, Capaldo B, Vigorito C, Giordano A, Guida R, Pardo F, Biondi B, Sacca L. A preliminary study of growth hormone in the treatment of dilated cardiomyopathy.  N Engl J Med. 1996;  334 809-814
    CrossrefPubMedGoogle Scholar
  • 11 Kahaly G, Olshausen K V, Mohr-Kahaly S, Erbel R, Boor S, Beyer J, Meyer J. Arrhythmia profile in acromegaly.  Eur Heart J. 1992;  13 51-56
    PubMedGoogle Scholar
  • 12 Karjalainen J, Mäntysaari M, Viitasalo M, Kujala U. Left ventricular mass, geometry, and filling in endurance athletes: association with exercise blood pressure.  J Appl Physiol. 1997;  82 531-537
    CrossrefPubMedGoogle Scholar
  • 13 Karila T AM, Koistinen H, Seppälä M, Koistinen R, Seppälä T A. Growth hormone induced increase in serum IGFBP-3 level is reversed by anabolic steroid in substance abusing power athletes.  Clin Endoc. 1998;  49 459-463
    CrossrefPubMedGoogle Scholar
  • 14 Klein I, Ojamaa K. Cardiovascular manifestations of endocrine disease.  J Clin Endocrinol Metab. 1992;  75 339-342
    CrossrefPubMedGoogle Scholar
  • 15 Krieg M, Smith K, Bartsch W. Demonstration of a specific androgen receptor in rat heart muscle: relationship between binding, metabolism, and tissue levels of androgens.  Endocrinology. 1978;  103 1686-1694
    PubMedGoogle Scholar
  • 16 Lie J T, Grossman S J. Pathology of the heart in acromegaly: anatomic findings in 27 autopsied patients.  Am Heart J. 1980;  100 41-52
    CrossrefPubMedGoogle Scholar
  • 17 Lim M, Barkan A L, Buda A J. Rapid reduction of left ventricular hypertrophy in acromegaly after suppression of growth hormone hypersecretion.  Ann Int Med. 1992;  117 719-726
    PubMedGoogle Scholar
  • 18 Maron B J. Structural features of the athlete heart as defined by echocardiography.  J Am Coll Cardiol. 1986;  7 190-203
    CrossrefPubMedGoogle Scholar
  • 19 Marsh J D, Lehmann M H, Ritchie R H, Gwathmey J K, Green G E, Schiebinger R J. Androgen receptors mediate hypertrophy in cardiac myocytes.  Circulation. 1998;  98 256-261
    CrossrefPubMedGoogle Scholar
  • 20 Mathews L S, Enberg B, Norstedt G. Regulation of rat growth hormone reseptor gene expression.  J Biol Chem. 1989;  17 9905-9910
    PubMedGoogle Scholar
  • 21 Melchert R B, Herron T J, Welder A A. The effect of anabolic-androgenic steroids on primary myocardial cell cultures.  Med Sci Sports Exerc. 1992;  24 266-272
    PubMedGoogle Scholar
  • 22 NIDA Research Report - Steroid Abuse and Addiction: NIH Publication No. 00 - 3721, Revised April,. 2000
    Google Scholar
  • 23 Nieminen M S, Rämo M P, Viitasalo M, Heikkila P, Karjalainen J, Mantysaari M, Heikkila J. Serious cardiovascular side effects of large doses of anabolic steroids in weight lifters.  Eur Heart J. 1996;  17 1576-1583
    CrossrefPubMedGoogle Scholar
  • 24 Osterziel K J, Strohm O, Schuler J, Friedrich M, Hanlein D, Willenbrock R, Anker S D, Poole-Wilson P A, Ranke M B, Dietz R. Randomised, double-blind, placebo-controlled trial of human recombinant growth hormone in patients with chronic heart failure due to dilated cardiomyopathy.  Lancet. 1998;  351 1233-1237
    CrossrefPubMedGoogle Scholar
  • 25 Palatini P, Giada F, Garavelli G, Sinisi F, Mario L, Michieletto M, Baldo-Enzi G. Cardiovascular effects of anabolic steroids in weight-trained subjects.  J Clin Pharmacol. 1996;  36 1132-1140
    CrossrefPubMedGoogle Scholar
  • 26 Pearson A C, Schiff M, Mrosek D, Labovitz A J, Williams G A. Left ventricular diastolic function in weight lifters.  Am J Cardiol. 1986;  58 1254-1259
    CrossrefPubMedGoogle Scholar
  • 27 Pelliccia A, Maron B J, Spataro A, Proschan M A, Spirito P. The upper limit of physiologic cardiac hypertrophy in highly trained elite athletes.  N Engl J Med. 1991;  324 295-301
    CrossrefPubMedGoogle Scholar
  • 28 Pelliccia A, Spataro A, Caselli G, Maron B J. Absence of left ventricular wall thickening in athletes engaged in intense power training.  Am J Cardiol. 1993;  72(14) 1048-1054
    CrossrefPubMedGoogle Scholar
  • 29 Rockhold R W. Cardiovascular toxity of anabolic steroids.  Annu Rev Pharmacol Toxicol. 1993;  33 497-520
    CrossrefPubMedGoogle Scholar
  • 30 Rossi E, Zuppi P, Pennestri F, Biasucci L M, Lombardo A, de Marinis L, Loperfido F. Acromegalic cardiomyopathy: left ventricular filling and hypertrophy in active and surgically treated disease.  Chest. 1992;  102 204-208
    PubMedGoogle Scholar
  • 31 Rämö P. Anabolic steroids alter the hemodynamic response of the canine left ventricle.  Acta Physiol Scand. 1987;  130 209-217
    PubMedGoogle Scholar
  • 32 Sachtleben T R, Berg K E, Elias B A, Cheatham J P, Felix G L, Hofschire P J. The effects of anabolic steroids; on myocardial structure and cardiovascular fitness.  Med Sci Sport Exec. 1993;  25 1240-1245
    PubMedGoogle Scholar
  • 33 Shapiro L M. Physiological left ventricular hypertrophy.  Br Heart J. 1984;  52 130-135
    PubMedGoogle Scholar
  • 34 Smallridge R C, Rajfer S, Davia J, Schaaf M. Acromegaly and the heart: an echocardiographic study.  Am J Med. 1979;  66 22-27
    CrossrefPubMedGoogle Scholar
  • 35 Stolt A, Karila T, Viitasalo M, Mäntysaari M, Kujala U, Karjalainen J. QT interval and QT dispersion in endurance athletes and in power athletes using large doses of anabolic steroids.  Am J Cardiol. 1999;  84 364-366
    CrossrefPubMedGoogle Scholar
  • 36 Thompson P D, Sadaniantz A, Cullinane E M, Bodziony K S, Catlin D H, Torek-Both G, Douglas P S. Left ventricular function is not impaired in weight lifters who use anabolic steroids.  J Am Coll Cardiol. 1992;  19 278-282
    PubMedGoogle Scholar
  • 37 Tomoda H. Effect of Oxymetholone on left ventricular dimensions in heart failure secondary to idiopathic dilated cardiomyopathy or to mitral or aortic regurgitation.  Am J Cardiol. 1999;  83 123-125
    CrossrefPubMedGoogle Scholar
  • 38 Urhausen A, Hölpes R, Kindermann W. One- and two-dimensional echocardiography in bodybuilders using anabolic steroids.  Eur J Appl Physiol. 1989;  58 633-640
    CrossrefPubMedGoogle Scholar

T. Karila

Laboratory of Substance Abuse · National Public Health Institute

Mannerheimintie 166 F · 00300 Helsinki · Finland ·

Phone: +358 9 4744 8425

Fax: +358 9 4744 8553

Email: tuomo.karila@ktl.fi