Abstract 16958: Anabolic-Androgenic Steroid Use is Associated With Premature Coronary Artery Disease
Background: Illicit anabolic-androgenic steroid (AAS) abuse is a world-wide public health problem. While mounting animal data and several recent human studies suggest that AAS abuse leads to premature cardiovascular disease, this association remains poorly understood. We aimed to compare the prevalence and burden of coronary atherosclerosis (CA) among long-term AAS users and age-matched non-users.
Methods: In this prospective cohort study, we evaluated 57 men with ≥2 years of lifetime AAS use (mean [SD] age: 43.3 [5.1] years) and 36 male non-users (mean age 43.0 [5.1] years). All participants underwent a structured clinical interview to obtain a detailed medical history, prior AAS usage and exercise exposure followed by coronary computed tomography angiography (CTA) using standard institutional clinical protocols. Two experienced readers blinded to AAS use assessed each study for the presence of calcified and non-calcified CA, severity of coronary stenosis, number of coronary segments with CA and total coronary plaque volume. Associations between AAS use and outcome variables were assessed by logistic and linear regression with adjustment for age, traditional CA risk factors, and lifetime use of other illicit drugs.
Results: We found CA, defined by the presence of plaque in at least one coronary segment, in 29 (51%) of the AAS users vs. 11 (25%) of non-users (adjusted OR [95% CI]: 2.7 [1.1, 7.1]; p = 0.038). Among AAS users, lifetime AAS dose was significantly associated with the severity of CA when assessed by the number of diseased coronary artery segments (coefficient [SE]: 0.36 [0.13] segments per 100 grams of lifetime AAS use; p = 0.009) and by total plaque volume (54.5 [24.7] mm3; p = 0.033). Of note, 4 (7%) AAS users, all under age 50, had received prior percutaneous coronary intervention as compared to none of the non-users.
Conclusions: Long-term AAS use increases the risk of premature CA, and cumulative lifetime AAS exposure is associated with the severity of CA. These findings demonstrate an important cardiovascular consequence of illicit AAS abuse with immediate clinical implications.
- © 2013 by American Heart Association, Inc.