AAS and Cardiovascular/Pulmonary Function

[Michael Scally MD]

[OA] Association between Testosterone Levels and Clinical Markers of Atherosclerosis
https://acmcasereport.com/pdf/ACMCR-v4-1389.pdf

1.1. Objectives: To investigate the association between testosterone levels and parameters obtained from the clinical exercise stress test from 119 middle-aged Swedish men.

1.2. Material and Methods: All subjects underwent a clinical exercise stress test and data on maximal heart rate, systolic blood pressure, diastolic blood pressure; and ST-segment levels in lead augmented vector foot (lead aVF) and lead left precordial voltage 5 (lead V5) were collected. Serum testosterone levels were measured.

Data on age, Body Mass Index (BMI), smoking, alcohol consumption, and family history of CardioVascular Diseases (CVD) were gathered. Men were classified into two groups: hypogonadal (testosterone ≤ 12 nmol/L), and eugonadal (testosterone > 12 nmol/L).

1.3. Results: We found a significant negative correlation between testosterone levels and maximal systolic blood pressure (r=-0.30, P=0.01). Hypogonadal men had significantly higher systolic blood pressure and more depressed ST-segment in lead V5 compared to eugonadal men (225mmHg vs. 210mmHg; p=0.01), (-0.13mm vs. 0.27mm; p=0.04), respectively.

In a multivariate regression analysis test adjusted for the age of subjects, BMI, smoking, alcohol consumption, and family history of CVD, a significant negative association was found only between testosterone and maximal systolic blood pressure (β =-0.829, p=0.04, 95% CI= -1.636, -0.022).

1.4. Conclusions: Our findings of an inverse relationship between testosterone levels and parameters of clinical exercise stress test suggest that low testosterone may be a cardiovascular risk factor.

 

[Michael Scally MD]

[OA] A Rare Case Report and Literature Review of Anabolic-Androgenic Steroids (AAS)-Induced Acute Myocardial Infarction

Anabolic-androgenic steroids (AAS) abuse is common in competitive athletes in order to enhance athletic performances. However, AAS abuse is often associated with deleterious side effects including but not limited to cardiovascular diseases, depression, hormonal abnormalities, and cancer.

We present a case of a 31-year-old male with a history of Crohn's disease on infliximab and chronic AAS use who had persistent retrosternal chest pain found to have an acute myocardial infarction (MI) without obvious cardiovascular risk factors.

Zhang Q, Shan KS, Raza A, Manda N, Nace T. A Rare Case Report and Literature Review of Anabolic-Androgenic Steroids (AAS)-Induced Acute Myocardial Infarction. Cureus. 2020;12(5):e8332. Published 2020 May 28. doi:10.7759/cureus.8332 A Rare Case Report and Literature Review of Anabolic-Androgenic Steroids (AAS)-Induced Acute Myocardial Infarction

 

[Michael Scally MD]

[OA] The Role of Iron in Mediating Testosterone's Effects on Erythropoiesis in Mice

Testosterone stimulates iron-dependent erythropoiesis and suppresses hepcidin. To clarify the role of iron in mediating testosterone's effects on erythropoiesis, we induced iron deficiency in mice by feeding low iron diet. Iron-replete and iron-deficient mice were treated weekly with testosterone propionate or vehicle for 3 weeks.

Testosterone treatment increased red cell count in iron-replete mice, but, surprisingly, testosterone reduced red cell count in iron-deficient mice. Splenic stress erythropoiesis was stimulated in iron-deficient mice relative to iron-replete mice, and further increased by testosterone treatment, as indicated by the increase in red pulp area, the number of nucleated erythroblasts, and expression levels of TfR1, GATA1, and other erythroid genes.

Testosterone treatment of iron-deficient mice increased the ratio of early-to-late erythroblasts in the spleen and bone marrow, and serum LDH level, consistent with ineffective erythropoiesis. In iron-deficient mice, erythropoietin levels were higher but erythropoietin-regulated genes were generally downregulated relative to iron-replete mice, suggesting erythropoietin resistance.

Conclusion: Testosterone treatment stimulates splenic stress erythropoiesis in iron-replete as well as iron-deficient mice. However, testosterone worsens anemia in iron-deficient mice because of ineffective erythropoiesis possibly due to erythropoietin resistance associated with iron deficiency. Iron plays an important role in mediating testosterone's effects on erythropoiesis.

Guo W, Abou Ghayda R, Schmidt PJ, Fleming MD, Bhasin S. The role of iron in mediating testosterone's effects on erythropoiesis in mice [published online ahead of print, 2020 Jul 15]. FASEB J. 2020;10.1096/fj.202000920RR. doi:10.1096/fj.202000920RR Error - Cookies Turned Off

 

[Michael Scally MD]

Effectiveness of Testosterone Therapy in Hypogonadal Patients and Its Controversial Adverse Impact on The Cardiovascular System

Testosterone is the major male hormone produced by testicles which are directly associated with man's appearance and secondary sexual developments. Androgen deficiency starts when the male hormonal level falls from its normal range though, in youngsters, the deficiency occurs due to disruption of the normal functioning of pituitary, hypothalamus glands, and testes. Thus, testosterone replacement therapy was already known for the treatment of androgen deficiency with lesser risks of producing cardiovascular problems.

Since from previous years, the treatment threshold in the form of testosterone replacement therapy has effectively increased to that extent that it was prescribed for those conditions which it was considered as inappropriate. However, there are some research studies and clinical trials available that proposed the higher risk of inducing cardiovascular disease with the use of testosterone replacement therapy.

Thus under the light of these results, the FDA has published the report of the increased risk of cardiovascular disease with the increased use of testosterone replacement therapy. Nevertheless, there is not a single trial available or designed that could evaluate the risk of cardiovascular events with the use of testosterone replacement therapy. As a result, the use of testosterone still questioned the cardiovascular safety of this replacement therapy.

Thus, this literature outlines the distribution pattern of disease by investigating the data and link between serum testosterone level and the cardiovascular disease, also the prescription data of testosterone replacement therapy patients and their tendency of inducing cardiovascular disease, meta-analysis and the trials regarding testosterone replacement therapy and its connection with the risks of causing cardiovascular disease and lastly, the possible effects of testosterone replacement therapy on the cardiovascular system.

This study aims to evaluate the available evidence regarding the use of testosterone replacement therapy when choosing it as a treatment plan for their patients.

Kharaba ZJ, Buabeid MA, Alfoteih YA. Effectiveness of testosterone therapy in hypogonadal patients and its controversial adverse impact on the cardiovascular system [published online ahead of print, 2020 Jul 21]. Crit Rev Toxicol. 2020;1-22. doi:10.1080/10408444.2020.1789944 https://www.tandfonline.com/doi/abs/10.1080/10408444.2020.1789944?journalCode=itxc20

 

[Michael Scally MD]

[OA] Late-Onset Hypogonadism: Reductio Ad Absurdum of The Cardiovascular Risk-Benefit of Testosterone Replacement Therapy

Background: Low testosterone (T) level is considered a marker of poor cardiovascular health. Ten years ago, the Testosterone in Older Men with Mobility Limitations (TOM) trial was discontinued due to a higher number of adverse events in men receiving T compared with placebo. Since then, several studies have investigated the risks of T replacement therapy (TRT) in late-onset hypogonadism (LOH).

Objective: To review the mechanism by which TRT could damage the cardiovascular system

Materials and Methods: Comprehensive literature search of recent clinical and experimental studies

Results: The mechanisms of T-mediated coronary vasodilation were reviewed with emphasis on calcium-activated and ATP-sensitive potassium ion channels. We showed how T regulates endothelial nitric oxide synthase (eNOS) and phosphoinositide 3-kinase/protein kinase B/eNOS signaling pathways in vessel walls and its direct effects on cardiomyocytes via β1-adrenergic and ryanodine receptors and provided data on myocardial infarction and heart failure.

Vascular smooth muscle senescence could be explained by the modulation of growth factors, matrix metalloproteinase-2, and angiotensin II by T. Furthermore, leukocyte trafficking, facilitated by changes in TNF-α, could explain some of the effects of T on atheromatous plaques.

Conflicting data on prothrombotic risk linked to platelet aggregation inhibition via NO-triggered arachidonate synthesis or increased aggregability due to enhanced thromboxane A in human platelets provide evidence regarding the hypotheses on plaque maturation and rupture risk. The effects of T on cardiac electrophysiology and oxygen delivery were also reviewed.

Discussion: The effects of TRT on the cardiovascular system are complex. Although molecular studies suggest a potential benefit, several clinical observations reveal neutral or occasionally detrimental effects, mostly due to confounding factors.

Conclusions: Attempts to demonstrate that TRT damages the cardiovascular system via systematic analysis of the putative mechanisms led to the contradiction of the initial hypothesis. Current evidence indiactes that TRT is safe once other comorbidities are addressed.

[OA] Sesti F, Pofi R, Minnetti M, Tenuta M, Gianfrilli D, Isidori AM. Late-onset hypogonadism: reductio ad absurdum of the cardiovascular risk-benefit of testosterone replacement therapy [published online ahead of print, 2020 Jul 31]. Andrology. 2020;10.1111/andr.12876. doi:10.1111/andr.12876 Error - Cookies Turned Off

 

[Michael Scally MD]

Hit or Miss: The New Cholesterol Targets

Drug treatment to reduce cholesterol to new target levels is now recommended in four moderate- to high-risk patient populations:

1. patients who have already sustained a cardiovascular event,

2. adult diabetic patients,

3. individuals with low density lipoprotein cholesterol levels ≥190 mg/dL and

4. individuals with an estimated 10-year cardiovascular risk ≥7.5%.

Achieving these cholesterol target levels did not confer any additional benefit in a systematic review of 35 randomised controlled trials. Recommending cholesterol lowering treatment based on estimated cardiovascular risk fails to identify many high-risk patients and may lead to unnecessary treatment of low-risk individuals.

The negative results of numerous cholesterol lowering randomised controlled trials call into question the validity of using low density lipoprotein cholesterol as a surrogate target for the prevention of cardiovascular disease.

DuBroff R, Malhotra A, de Lorgeril M. Hit or miss: the new cholesterol targets. BMJ Evidence-Based Medicine. Published Online First: 03 August 2020. doi: 10.1136/bmjebm-2020-111413 Hit or miss: the new cholesterol targets

 

[Michael Scally MD]

Hit or Miss: The New Cholesterol Targets

Drug treatment to reduce cholesterol to new target levels is now recommended in four moderate- to high-risk patient populations:

1. patients who have already sustained a cardiovascular event,

2. adult diabetic patients,

3. individuals with low density lipoprotein cholesterol levels ≥190 mg/dL and

4. individuals with an estimated 10-year cardiovascular risk ≥7.5%.

Achieving these cholesterol target levels did not confer any additional benefit in a systematic review of 35 randomised controlled trials. Recommending cholesterol lowering treatment based on estimated cardiovascular risk fails to identify many high-risk patients and may lead to unnecessary treatment of low-risk individuals.

The negative results of numerous cholesterol lowering randomised controlled trials call into question the validity of using low density lipoprotein cholesterol as a surrogate target for the prevention of cardiovascular disease.

DuBroff R, Malhotra A, de Lorgeril M. Hit or miss: the new cholesterol targets. BMJ Evidence-Based Medicine. Published Online First: 03 August 2020. doi: 10.1136/bmjebm-2020-111413 Hit or miss: the new cholesterol targets

[OA] Expert Reaction to Analysis of Clinical Trial Data on Cholesterol Lowering Drugs and Targets For ‘Bad’ Cholesterol Levels
expert reaction to analysis of clinical trial data on cholesterol lowering drugs and targets for ‘bad’ cholesterol levels | Science Media Centre

An analysis, published in BMJ Evidence Based Medicine, looked at clinical trial data on cholesterol lowering drugs and targets for ‘bad’ cholesterol levels.

Prof John Cleland, Professor at the Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, said: …

Prof Alun Hughes, Professor of Cardiovascular Physiology and Pharmacology, Department of Population Science & Experimental Medicine, UCL, said: …

Prof Kevin McConway, Emeritus Professor of Applied Statistics, The Open University, said: …

Prof Stuart Pocock, Professor of Medical Statistics, London School of Hygiene & Tropical Medicine, said: …

Prof Stephen Evans, Professor of Pharmacoepidemiology, London School of Hygiene & Tropical Medicine, said: …

Prof Robert Storey, Professor of Cardiology, University of Sheffield, said: …

 

[Michael Scally MD]

[OA] [GMAFB] Acute Myocardial Infarction with Cardiogenic Shock in A Young Physically Active Physician Concurrently Using the Anabolic Steroid Sustanon

The association between ischemic heart disease (IHD) and the concurrent use of anabolic androgenic steroids (AASs) is underestimated in clinical settings. The tendency of patients to not disclose AASs use may explain this underestimation.

In the present case report, the clinical case of a 26-year-old physically active male, who was a physician, without any classical coronary risk factors, who presented with chest pain that was misdiagnosed by the peripheral care unit as skeletal muscle pain is described. Later, the patient was brought to our central hospital (King Abdullah University Hospital) suffering from a massive acute myocardial infarction with marked ECG changes and cardiogenic shock.

Following stabilization of his condition, a detailed history of the patient was taken, during which the patient admitted that he was a chronic user of the anabolic steroid sustanon (250 mg, once/week for 6 months) and amino acid supplements (whey protein isolate, 6 tabs every day for 1 year).

Specific cardiac markers were increased and the patient exhibited dynamic ischemic changes in his electrocardiogram. Notably, the coronary angiogram of the patient demonstrated ostial occlusion of the left anterior descending artery, which was associated with mid-right coronary artery embolic obstruction.

Other than the anabolic steroids and protein supplementation use, the patient history, examination and lab evaluation were normal. During follow up, the patient continued to suffer heart failure with low ejection fraction. In addition, he developed apical thrombus 2 months after primary admission. The patient developed tachycardia in spite of optimal medical treatment and finally received an implantable cardioverter defibrillator.

Physicians should always be aware of the possibility of AASs use in young physically active patients. IHD should always be suspected and investigated with typical chest pain in healthy young patients, even if regular risk factors are not present. Medical professionals should not be excluded as potential AASs users/abusers.

Alrabadi N, Jarrah MI, Alzoubi KH. Acute myocardial infarction with cardiogenic shock in a young physically active physician concurrently using the anabolic steroid sustanon: A case report. Biomed Rep. 2020;13(3):14. doi:10.3892/br.2020.1321 Acute myocardial infarction with cardiogenic shock in a young physically active physician concurrently using the anabolic steroid sustanon: A case report

 

[Michael Scally MD]

Hypogonadism Management and Cardiovascular Health

In the early days of its use, testosterone therapy faced skepticism regarding its safety and efficacy. After a converging consensus that testosterone therapy was safe and effective for the treatment of hypogonadism, several recent studies showed adverse cardiovascular outcomes associated with testosterone treatment, ultimately resulting in a mandated FDA label warning about the unknown safety of testosterone therapy.

Given the clear efficacy of testosterone therapy in the treatment of hypogonadism, establishing the safety of this therapeutic tool is essential. This article summarizes the current evidence regarding the cardiovascular safety of testosterone therapy for the management of hypogonadism, as well as the proposed mechanisms that may explain testosterone's underlying effects.

Auerbach JM, Khera M. Hypogonadism management and cardiovascular health [published online ahead of print, 2020 Aug 17]. Postgrad Med. 2020;10.1080/00325481.2020.1805917. doi:10.1080/00325481.2020.1805917 https://www.tandfonline.com/doi/abs/10.1080/00325481.2020.1805917?journalCode=ipgm20

 

[Michael Scally MD]

[OA] Anabolic Steroids and Cardiovascular Outcomes: The Controversy

Anabolic steroids (AS) are synthetic derivatives of the male sex hormone testosterone. The use of AS is not limited to bodybuilders and athletes, but non-athletes also use them. It is used to enhance athletic performance, induce muscle hypertrophy, and augment male sexual characteristics.

AS use is associated with a wide range of side effects and potential cardiovascular complications. In this article, we have searched the available literature to investigate the association between AS use and cardiovascular disease (CVD). The results revealed that AS was linked to lipid metabolism derangements, hypertension, coagulation disorders, and cardiomyopathy.

We concluded, based on the relevant data, that there was evidence that suggests an association with CVD, primarily myocardial infarction, fatal arrhythmias, and cardiomyopathy in AS users. The general population should be informed of the risk. Also, methods of primary and secondary prevention should be implemented to mitigate the risk of CVD secondary to AS.

Perry JC, Schuetz TM, Memon MD, Faiz S, Cancarevic I. Anabolic Steroids and Cardiovascular Outcomes: The Controversy. Cureus. 2020;12(7):e9333. Published 2020 Jul 22. doi:10.7759/cureus.9333 Anabolic Steroids and Cardiovascular Outcomes: The Controversy

 

[Michael Scally MD]

[OA] Acute Myocardial Infarction in a Young Bodybuilder: A Case Report and Review of the Literature

BACKGROUND Misuse of androgenic anabolic steroids (AAS) is a current practice associated with vigorous bodybuilding for muscular hypertrophy, especially among gym practitioners and bodybuilders, influenced by the culture of body image. In addition to liver, psychiatric, genital, urinary, dermatological, and musculoskeletal complications, AAS misuse reportedly can lead to development of cardiovascular complications, such as hypertension, dyslipidemia, cardiac hypertrophy, and early coronary disease, and potentially acute myocardial infarction (AMI) and sudden death.

CASE REPORT A 26-year-old male farmer who was also an amateur bodybuilder developed an extensive Killip Class I AMI in the anterior wall while using AAS. A few days before the acute event, his lipid and hormone levels were measured and found to be significantly elevated. The patient was asymptomatic after left anterior descending branch angioplasty, but he had significant electrocardiographic sequelae and ventricular dysfunction.

CONCLUSIONS We describe the case of a young male bodybuilder using AAS who presented with AMI and was treated with primary angioplasty. Documentation of high levels of lipids and hormones 1 week before the acute event suggests some relationship between AAS and cardiovascular disease.

The main effects of using these steroids on the cardiovascular system are reviewed. It is time for a new global warning about the risks of misusing AAS to obtain muscle hypertrophy. Based on current medical knowledge, these hormones should not be prescribed without a clear indication for their use.

Melhem AJ Jr, Araújo AC, Figueiredo FNS, Figueiredo DLA. Acute Myocardial Infarction in a Young Bodybuilder: A Case Report and Review of the Literature. Am J Case Rep. 2020;21:e924796. Published 2020 Aug 27. doi:10.12659/AJCR.924796 Acute Myocardial Infarction in a Young Bodybuilder: A Case Report and Review of the Literature

 

[malfeasance]

[OA] [GMAFB] Acute Myocardial Infarction with Cardiogenic Shock in A Young Physically Active Physician Concurrently Using the Anabolic Steroid Sustanon

The association between ischemic heart disease (IHD) and the concurrent use of anabolic androgenic steroids (AASs) is underestimated in clinical settings. The tendency of patients to not disclose AASs use may explain this underestimation.

In the present case report, the clinical case of a 26-year-old physically active male, who was a physician, without any classical coronary risk factors, who presented with chest pain that was misdiagnosed by the peripheral care unit as skeletal muscle pain is described. Later, the patient was brought to our central hospital (King Abdullah University Hospital) suffering from a massive acute myocardial infarction with marked ECG changes and cardiogenic shock.

Following stabilization of his condition, a detailed history of the patient was taken, during which the patient admitted that he was a chronic user of the anabolic steroid sustanon (250 mg, once/week for 6 months) and amino acid supplements (whey protein isolate, 6 tabs every day for 1 year).

Specific cardiac markers were increased and the patient exhibited dynamic ischemic changes in his electrocardiogram. Notably, the coronary angiogram of the patient demonstrated ostial occlusion of the left anterior descending artery, which was associated with mid-right coronary artery embolic obstruction.

Other than the anabolic steroids and protein supplementation use, the patient history, examination and lab evaluation were normal. During follow up, the patient continued to suffer heart failure with low ejection fraction. In addition, he developed apical thrombus 2 months after primary admission. The patient developed tachycardia in spite of optimal medical treatment and finally received an implantable cardioverter defibrillator.

Physicians should always be aware of the possibility of AASs use in young physically active patients. IHD should always be suspected and investigated with typical chest pain in healthy young patients, even if regular risk factors are not present. Medical professionals should not be excluded as potential AASs users/abusers.

Alrabadi N, Jarrah MI, Alzoubi KH. Acute myocardial infarction with cardiogenic shock in a young physically active physician concurrently using the anabolic steroid sustanon: A case report. Biomed Rep. 2020;13(3):14. doi:10.3892/br.2020.1321 Acute myocardial infarction with cardiogenic shock in a young physically active physician concurrently using the anabolic steroid sustanon: A case report

250 mg a week of testosterone for six months leads to a heart attack in a 26 year old??? Complications? Pacemaker?

WTF?

Think he disclosed everything?

 

[Michael Scally MD]

Anabolic-Androgenic Steroid Abuse Impairs Fibrin Clot Lysis

Abuse of anabolic-androgenic steroids (AASs) is suspected to increase the risk of cardiovascular disease (CVD) and cardiovascular mortality in otherwise healthy individuals. AAS abuse may increase the incidence of CVD by altering the hemostatic balance toward a procoagulant state. Studies on the effect of AAS abuse on the fibrinolytic system, however, have either demonstrated a profibrinolytic effect or no effect of AAS abuse, but the overall effect of AAS on fibrinolysis has not been addressed so far.

This cross-sectional study investigated the effect of AAS on fibrin clot lysis, fibrin structure, and the hemostatic proteins, potentially affecting these measures in current and former AAS abusers and healthy age-matched controls. The study population consisted of 37 current and 33 former AAS abusers, along with 30 healthy age-matched controls. Fibrin clot lysis, fibrin structure properties, fibrinogen, coagulation factor XIII (FXIII) plasminogen, plasmin inhibitor, plasminogen activator inhibitor-1 (PAI-1), and thrombin activatable fibrinolysis inhibitor (TAFI) were determined.

Fibrin clot lysis was significantly reduced in participants abusing AAS compared with former abusers and controls (p < 0.001). Plasma fibrinogen, plasminogen, and plasmin inhibitor were significantly increased in current abusers (p < 0.05). No significant differences were observed with respect to measures of fibrin structure properties, PAI-1, and TAFI (p > 0.05).

In conclusion, AAS abuse depresses fibrin clot lysis. This effect is not associated with alterations in fibrin structure but is rather caused by increased plasma concentrations of fibrinogen, FXIII, and plasmin inhibitor. These findings suggest that AAS abuse may be associated with increased thrombotic disease.

Sidelmann JJ, Gram JB, Rasmussen JJ, Kistorp C. Anabolic-Androgenic Steroid Abuse Impairs Fibrin Clot Lysis. Semin Thromb Hemost. 2020 Oct 5. doi: 10.1055/s-0040-1714398. Epub ahead of print. PMID: 33017849. https://www.thieme-connect.de/products/ejournals/abstract/10.1055/s-0040-1714398

 

[Michael Scally MD]

Transdermal Testosterone Attenuates Drug-Induced Lengthening of Both Early and Late Ventricular Repolarization

We have previously reported that transdermal testosterone attenuates drug‐induced QT interval lengthening in older men. However, it is unknown whether this is due to modulation of early ventricular repolarization, late repolarization, or both.

In a secondary analysis of a prospective, randomized, double‐blind, placebo‐controlled three‐way crossover study, we determined if transdermal testosterone and oral progesterone attenuate drug‐induced lengthening of early and late ventricular repolarization, represented by the electrocardiographic measurements J‐Tpeakc and Tpeak‐Tend, respectively, as well as Tpeak‐Tend/QT, a measure of transmural dispersion of repolarization.

Male volunteers ≥ 65 years of age (n=14) were randomized to receive transdermal testosterone 100 mg, oral progesterone 400 mg, or matching transdermal/oral placebo daily for 7 days. On the morning following the 7th day, subjects received intravenous ibutilide 0.003 mg/kg, after which ECGs were performed serially. One subject was excluded due to difficulty in T‐wave interpretation.

Pre‐ibutilide J‐Tpeakc was lower during the testosterone phase than during progesterone and placebo (216±23 vs 227±28 vs 227±21 ms, p=0.002). Maximum post‐ibutilide J‐Tpeakc was also lower during the testosterone phase (233±22 vs 246±29 vs 248±23 ms, p<0.0001). Pre‐ibutilide Tpeak‐Tend was not significantly different during the three phases, but maximum post‐ibutilide Tpeak‐Tend was lower during the testosterone phase (80±12 vs 89±18 vs 86±15 ms, p=0.002). Maximum Tpeak‐Tend/QT was also lower during the testosterone phase (0.199±0.023 vs 0.216±0.035 vs 0.209±0.031, p=0.005). Progesterone exerted minimal effect on drug‐induced lengthening of J‐Tpeakc, and no effect on Tpeak‐Tend or Tpeak‐Tend/QT.

Transdermal testosterone attenuates drug‐induced lengthening of both early and late ventricular repolarization in older men.

Muensterman ET, Jaynes HA, Sowinski KM, et al. Transdermal Testosterone Attenuates Drug-Induced Lengthening of Both Early and Late Ventricular Repolarization in Older Men. Clinical Pharmacology & Therapeutics 2020;n/a. https://doi.org/10.1002/cpt.2072

 

[Michael Scally MD]

Aortopathic Effect of Androgenic Anabolic Steroids

Background: Anabolic androgens have been reported to be associated with cardiovascular complications. One study revealed that increase in vascular stiffness in bodybuilders is associated with anabolic androgens and improvement in vascular function may occur following anabolic androgens discontinuation. The aim of this study was to investigate any possible relation between aortic elastic properties and anabolic androgens.

Methods: Study population was divided into 3 groups: Group-1 [n = 35] consisted of bodybuilders who denied any current or previous use of anabolic androgens. Group-2 [n = 18] was bodybuilders with regular using of anabolic androgens for at least 2 year prior to the start of our study. Group-3 was 13 healthy age-matched sedentary men as a control group. Cardiac echocardiography was performed in the bodybuilders and controls and indexes of aortic function were calculated.

Results: Aortic stiffness was approximately twofold higher in anabolic androgens user bodybuilders compared with drug-free bodybuilders [P < 0.001].

Conclusion: The present study demonstrates that chronic anabolic androgens use clearly produces significant decrease in the elastic properties of aorta.

Bigi MAB, Abtahi F, Namdar ZM, Amirhakimi A, Hosseinpour A, Shahrzad S, Aslani A. Aortopathic effect of androgenic anabolic steroids. J Echocardiogr. 2020 Oct 12. doi: 10.1007/s12574-020-00495-5. Epub ahead of print. PMID: 33044714. Aortopathic effect of androgenic anabolic steroids

 

[Michael Scally MD]

[OA] Anabolic Steroid Use and Aortic Dissection in Athletes: A Case Series

The use of anabolic steroids in supraphysiologic doses has grown in the last decade as doping drugs in athletes. The high dose of anabolic-androgenic steroids (AAS) causes cardiomyopathy, hypertension, thrombosis, myocardial infarction (MI), weakness of connective tissue, and its sequelae such as tendon injury and aortic dissection.

Dissection of the ascending aorta is an uncommon injury that has been recognized with increasing frequency in bodybuilders in recent years. It has been proposed that such cases commonly accompany the weakening of connective tissue and must be actively evaluated in the presence of anabolic steroid usage.

We present a case series of isolated ascending aorta dissection in athletes who were bodybuilders. All cases were evaluated by transthoracic echocardiography (TTE) and laboratory exams. These cases also served as a reminder of the risks of ascending aorta dissection with AAS, especially in strength athletes who place high demands on their musculoskeletal structures.

The results of the current study suggested that anabolic steroid abuse may be associated with detrimental effects on the myocardium represented as cardiomyopathy or atherosclerotic changes in the coronary artery as MI. These findings also strongly suggest that anabolic steroid treatment predisposes the individual to aortic dissection, especially when the patients are exercised.

Heydari A, Asadmobini A, Sabzi F. Anabolic Steroid Use and Aortic Dissection in Athletes: A Case Series. Oman Med J. 2020 Sep 30;35(5):e179. doi: 10.5001/omj.2020.120. PMID: 33083037; PMCID: PMC7568822. Oman Medical Journal-Archive

 

[Michael Scally MD]

[OA] Effect of Testosterone Treatment on Cardiovascular Events in Men: Protocol for a Systematic Literature Review and Meta-Analysis

Background: Testosterone prescriptions have increased dramatically in recent decades, with increasing usage in men. Despite epidemiological associations reported high circulating concentrations of endogenous androgens and low risk of cardiovascular events and mortality, the effects of exogenous androgens in the form of testosterone therapy for maintaining physiological circulating androgen concentrations on the cardiovascular system remain uncertain with no published meta-analysis on this topic.

Objective: The aim of this study was to investigate the effects of prescribed testosterone treatment, in all forms and durations, from well-developed randomized controlled trials, on cardiovascular events in men aged 18 years or older.

Methods: Peer-reviewed journal articles published from 1980 to 2019 will be searched from databases (ie CINAHL [Cumulated Index to Nursing and Allied Health Literature], Embase, Medline, Scopus, Cochrane Controlled Register of Trials as well as the Clinical Trial Registry). Randomized controlled trials or cluster randomized controlled trials with at least one intervention arm of testosterone and a control group of usual care or no testosterone treatment will be included in this review and meta-analysis.

Studies on men with previous cardiovascular events or cardiac vascularization (coronary bypass surgery or percutaneous coronary intervention) will be excluded. Data related to primary outcomes such as clinical events of any type of stroke or transient ischemic attack, nonfatal myocardial infarction or acute coronary syndrome, emergency coronary artery revascularization, carotid surgery, cardiac mortality, and all-cause mortality will be extracted for analysis. The criteria for PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) will be followed in the evaluation of evidence.

Results: Search terms have been piloted and finalized. This study will be completed by the end of 2020.

Conclusions: This protocol will guide a systematic literature review of the evidence around prescribed testosterone and its effect on cardiovascular events in men aged 18 years or older. The findings will inform clinical management of hypogonadal men.

Chih H, Reid CM, Yeap BB, Dwivedi G. Effect of Testosterone Treatment on Cardiovascular Events in Men: Protocol for a Systematic Literature Review and Meta-Analysis. JMIR Res Protoc. 2020 Oct 29;9(10):e15163. doi: 10.2196/15163. PMID: 33118952. JRP - Effect of Testosterone Treatment on Cardiovascular Events in Men: Protocol for a Systematic Literature Review and Meta-Analysis | Chih | JMIR Research Protocols

 

[Michael Scally MD]

...

 

[Michael Scally MD]

Male Sexual Health and Cardiovascular Disease

Purpose of Review - To provide an updated review on the association of erectile dysfunction (ED), male hypogonadism, and testosterone therapy with cardiovascular disease (CVD).

Recent Findings - Direct evidence links male sexual dysfunction to CVD, including higher coronary artery calcium scores, carotid narrowing, and more severe coronary artery disease.

While questions about the role of ED in predicting cardiovascular risk independent of shared comorbidities have lingered, the most recent analyses favor a diagnosis of ED as a strong independent predictor of adverse cardiac events. ED has now been incorporated into the widely used QRISK3 calculator for cardiovascular risk assessment and may influence clinical decision-making about primary prevention interventions.

Controversy also surrounds changes in testosterone labeling that highlight potential cardiovascular risks. While continuing to remain contentious, the most extensive meta-analyses conclude that low endogenous testosterone is independently associated with increased cardiovascular risk and that testosterone therapy does not appear to carry increased risk in most populations.

Summary - The assessment of ED is an effective tool in predicting cardiovascular risk and may influence clinical decision-making with regard to primary prevention interventions. The associations between endogenous testosterone levels, testosterone therapy, and cardiovascular risk remain controversial.

Greear, G.M., Garg, N. & Hsieh, T. Male Sexual Health and Cardiovascular Disease. Curr Sex Health Rep (2020). https://doi.org/10.1007/s11930-020-00281-5

 

[malfeasance]

Thanks for continuing to post in this thread, Dr. Scally. Many of us are reading the posts.