Endocrine Abstracts

High doses of anabolic-androgenic steroids (AAS), especially when taken concomitantly with multiple other preparations, can lead to a decrease in high-density lipoprotein (HDL) cholesterol and an increase in low-density lipoprotein (LDL) cholesterol. After long-term, high-dose AAS abuse, atherosclerosis may develop, leading to coronary artery disease, cerebral vascular disease or peripheral artery disease. The degree of atherosclerosis appears to be dependent on the duration of AAS exposure. Long-term AAS users show altered electrophysiological activity of the myocardium with a significantly higher incidence of abnormal electrocardiograms after exercise. In some cases, AAS abuse resulted in a long-term elevation of blood pressure. Activation of the sympathetic autonomic nervous system, decreased parasympathetic modulation and structural cardiac changes appear to be possible causes of arterial hypertension. Some AAS in high doses cause water retention, which may be associated with arterial hypertension. AAS can cause concentric left ventricular myocardial hypertrophy, may also impair left ventricular diastolic function, which seems to be irreversible and detectable even after several years of AAS withdrawal. AAS abuse can cause a sudden cardiac death in apparently healthy young athletes. The most common causes of sudden death in young competitive athletes are hypertrophic cardiomyopathy and previously undiagnosed congenital heart failure. Other causes include coronary artery spasms, premature coronary atherosclerosis, thrombotic coronary artery occlusions due to an increased platelet aggregation and an increase in haematocrit, and direct cardiotoxic effects on cardiomyocytes.