Anabolic androgenic steroid use is associated with ventricular dysfunction on cardiac MRI in strength trained athletes

Int J Cardiol. 2013 Aug 10;167(3):664-8. doi: 10.1016/j.ijcard.2012.03.072. Epub 2012 Mar 28.


Background: Uncertainty remains about possible cardiac adaptation to resistance training. Androgenic anabolic steroids (AAS) use plays a potential role and may have adverse cardiovascular effects.

Objective: To elucidate the effect of resistance training and of AAS-use on cardiac dimensions and function.

Participants: Cardiac magnetic resonance (CMR) were performed in 156 male subjects aged 18-40 years: 52 non-athletes (maximum of 3 exercise hours/week), 52 strength-endurance (high dynamic-high static, HD-HS) athletes and 52 strength (low dynamic-high static, LD-HS) trained athletes (athletes ≥ 6 exercise hours/week). 28 LD-HS athletes denied and 24 admitted to AAS use for an average duration of 5 years (range 3 months-20 years).

Results: No significant differences were found between non-athletes and non-AAS-using LD-HS athletes. AAS-using LD-HS athletes had significantly larger LV and RV volumes and LV wall mass than non-AAS-using LD-HS athletes, but lower than HD-HS athletes. In comparison to all other groups AAS-using LD-HS athletes showed lower ejection fractions of both ventricles (LV/RV EF 51/48% versus 55-57/51-52%) and lower E/A ratios (LV/RV 1.5/1.2 versus 1.9-2.0/1.4-1.5) as an indirect measure of diastolic function. Linear regression models demonstrated a significant effect of AAS-use on LV EDV, LV EDM, systolic function and mitral valve E/A ratio (all ANOVA-tests p<0.05).

Conclusions: Strength athletes who use AAS show significantly different cardiac dimensions and biventricular systolic dysfunction and impaired ventricular inflow as compared to non-athletes and non-AAS-using strength athletes. Increased ventricular volume and mass did not exceed that of strength-endurance athletes. These findings may help raise awareness of the consequences of AAS use.

Keywords: Anabolic androgenic steroids; Athletes; Cardiac MRI; Cardiac adaptation; Strength training; Ventricular function.

MeSH terms

  • Adolescent
  • Adult
  • Anabolic Agents / adverse effects
  • Athletes*
  • Cross-Sectional Studies
  • Humans
  • Magnetic Resonance Imaging, Cine
  • Male
  • Observer Variation
  • Resistance Training* / methods
  • Steroids / adverse effects
  • Testosterone Congeners / adverse effects*
  • Ventricular Dysfunction / chemically induced*
  • Ventricular Dysfunction / diagnosis*
  • Young Adult


  • Anabolic Agents
  • Steroids
  • Testosterone Congeners