“Every practicing cardiologist should be thinking about steroid use as potential patient risk factor for heart disease,” says Aaron Baggish, MD, associate director of the Massachusetts General Hospital (MGH) Cardiovascular Performance Program.

Baggish is the co-lead author of new research indicating chronic anabolic-androgenic steroid use may be damaging to the heart and the coronary arteries.

The findings, published in the American Heart Association’s journal Circulation, show long-term use of illicit steroids can reduce the heart’s ability to pump blood throughout the body, damage the heart muscle’s ability to relax and may also cause atherosclerotic coronary artery disease – a buildup of plaque that can lead to heart attacks.

Anabolic-androgenic steroids are synthetic substances that mimic naturally occurring testosterone, promoting muscle growth and the development of male sexual characteristics. “There’s a common misconception that steroid abuse is confined to elite and professional athletes,” says Baggish. “Prior work from our group has suggested between 3 to 4 million men in America have used steroids at some point for (the goal of) either improving athletic performance or simply looking better.”

Baggish and his team of researchers conducted an observational study of 140 male weightlifters. Eighty-six of them used anabolic steroids and 54 were non-users. Of the users, 58 were on the drug and 28 were off the drug during evaluations. The off-drug users had last used steroids an average of 15 months prior to the study.

“Our findings were quite sobering,” says Baggish. The researchers discovered the heart's main pumping chamber was significantly weaker during contraction (systolic function) in those taking anabolic steroids compared to non-users. But diastolic function, when the main pumping chamber relaxes and fills with blood, was impaired for both on-drug and off-drug anabolic steroid users, suggesting a more permanent heart problem from the chronic use of steroids.

Compared to non-users, “the anabolic steroid users also displayed higher blood pressure and a higher prevalence of bad (LDL) cholesterol in their blood,” says Baggish.

Using CT scans, one portion of the study also sought to examine a potential link between anabolic steroid use and coronary artery disease. It revealed strong associations between long duration or lifetime use of illicit anabolic steroid use and the amount of plaque build-up in the coronary arteries.

“This is important, especially as we see men approaching middle-age,” says Baggish. “If we don’t ask about this, we won’t find it.”

For more on the MGH Cardiovascular Performance Program, please visit http://www.massgeneral.org/heartcenter/services/treatmentprograms.aspx?id=1364.