Sudden Cardiac Death in Anabolic-Androgenic Steroid Users

[malfeasance]

Posted by, and cut and pasted from, a Nov 6 post by Michael Scally MD in his AAS and Cardiovascular/Pulmonary Function thread. AAS and Cardiovascular/Pulmonary Function




[OA] Sudden Cardiac Death in Anabolic-Androgenic Steroid Users

Background and objectives: Anabolic-androgenic steroids (AASs) are a group of synthetic molecules derived from testosterone and its related precursors. AASs are widely used illicitly by adolescents and athletes, especially by bodybuilders, both for aesthetic uses and as performance enhancers to increase muscle growth and lean body mass. When used illicitly they can damage health and cause disorders affecting several functions.

Sudden cardiac death (SCD) is the most common medical cause of death in athletes. SCD in athletes has also been associated with the use of performance-enhancing drugs. This review aimed to focus on deaths related to AAS abuse to investigate the cardiac pathophysiological mechanism that underlies this type of death, which still needs to be fully investigated.

Materials and Methods: This review was conducted using PubMed Central and Google Scholar databases, until 21 July 2020, using the following key terms: "((Sudden cardiac death) OR (Sudden death)) AND ((androgenic anabolic steroid) OR (androgenic anabolic steroids) OR (anabolic-androgenic steroids) OR (anabolic-androgenic steroid))". Thirteen articles met the inclusion and exclusion criteria, for a total of 33 reported cases.

Results: Of the 33 cases, 31 (93.9%) were males while only 2 (6.1%) were females. Mean age was 29.79 and, among sportsmen, the most represented sports activity was bodybuilding. In all cases there was a history of AAS abuse or a physical phenotype suggesting AAS use; the total usage period was unspecified in most cases.

In 24 cases the results of the toxicological analysis were reported. The most detected AASs were nandrolone, testosterone, and stanozolol. The most frequently reported macroscopic alterations were cardiomegaly and left ventricular hypertrophy, while the histological alterations were foci of fibrosis and necrosis of the myocardial tissue.

Conclusions: Four principal mechanisms responsible for SCD have been proposed in AAS abusers: the atherogenic model, the thrombosis model, the model of vasospasm induced by the release of nitric oxide, and the direct myocardial injury model. Hypertrophy, fibrosis, and necrosis represent a substrate for arrhythmias, especially when combined with exercise. Indeed, AAS use has been shown to change physiological cardiac remodeling of athletes to pathophysiological cardiac hypertrophy with an increased risk of life-threatening arrhythmias.

Torrisi M, Pennisi G, Russo I, et al. Sudden Cardiac Death in Anabolic-Androgenic Steroid Users: A Literature Review. Medicina (Kaunas). 2020 Nov 4;56(11):E587. doi: 10.3390/medicina56110587. PMID: 33158202. https://www.mdpi.com/1010-660X/56/11/587/htm

 

[Cashton]

uhmm how do we prevent this?

 

[RoidRage420]

uhmm how do we prevent this?

Don't juice lol

 

[grey]

uhmm how do we prevent this?

Wait to use AAS until you are old like me.


*Something* WILL kill us eventually.


For men it is highly likely to be a cardiac event, AAS or no.


But if you start using in your 20's and 20's well... look at the entire pro wrestling death roster for the results.

20 years of LVH starting at age 22 is a MUCH more problematic health situation than 20 years of LVH starting at age 40 or 50.

 

[BigDaddyV]

Wait to use AAS until you are old like me.


*Something* WILL kill us eventually.


For men it is highly likely to be a cardiac event, AAS or no.


But if you start using in your 20's and 20's well... look at the entire pro wrestling death roster for the results.

20 years of LVH starting at age 22 is a MUCH more problematic health situation than 20 years of LVH starting at age 40 or 50.

Oops ‍ *shrug* ‍

 

[Uncle Ted]

The body building world is full of guys falling over dead of heart attacks.

Even looking at Arnold's era, lots of his buddies seemed to have kicked off dead with heart attacks.

Lets be honest, this stuff damages endothelial cells, heart muscle, we are spitting out a lot more red cells causing our hearts to work harder to pump this sludge.

I'm conscious of my heart every night I go to bed when the thing is thumping hard, my head pounding with every pulse. Stroke or heart attack, one day it will happen.

 

[stone988]

The body building world is full of guys falling over dead of heart attacks.

Even looking at Arnold's era, lots of his buddies seemed to have kicked off dead with heart attacks.

Lets be honest, this stuff damages endothelial cells, heart muscle, we are spitting out a lot more red cells causing our hearts to work harder to pump this sludge.

I'm conscious of my heart every night I go to bed when the thing is thumping hard, my head pounding with every pulse. Stroke or heart attack, one day it will happen.

News flash, Americans is full of guys falling over from heart attacks. Anytime there is abnormal increase in body weight this can happen. Heart disease is the leading cause of death for men in the United States, killing 347,879 men in 2017—that's about 1 in every 4 male deaths.Jan 31, 2020
Another shit study that leaves out important variables and ignores common sense and actual data and science. AAS users statistically have far fewer deaths from heart issues then general populations. lets us know when 1 and 4 bodybuilders die of heart failure in one year.

 

[Millard]

AAS users statistically have far fewer deaths from heart issues then general populations.

Evidence?

 

[All Nats McGee]

The key to long term health success is less androgens point blank. Most anti aging experts say TRT will likely shorten your lifespan compared to someone with lower t levels. The answer is use low dose of the more tissue selective anabolics. So no dirty shit like tren or test.

 

[Millard]

But if you start using in your 20's and 20's well... look at the entire pro wrestling death roster for the results.

20 years of LVH starting at age 22 is a MUCH more problematic health situation than 20 years of LVH starting at age 40 or 50.

I don't think 20 years of heavy and/or continuous AAS use is good in either scenario.

As far as the best decade in your life to use AAS, please allow me to entertain a contrarian point of view.

I'm not sure I would agree that it is safer to wait and use AAS when you are older than younger. Of course, if death is an outcome, then obviously it's better to wait until your later years.

However, I would speculate that is is far riskier for older men (40s, 50s, and older) to use supraphysiologic dosages of AAS than younger men (20s).

In general, the 20-somethings have an advantage due to their better overall health, freedom from disease, enhanced exercise tolerance and recovery, and general system plasticity. As an added bonus, some of the muscle-building alterations from AAS following discontinuation are increasingly appearing to be semi-permanent (persisting for many years and maybe decades).

This could very well be the case for those who use AAS for a limited period e.g. 5 years or less and perhaps <10 years. Once it becomes a lifestyle, 10, 20, 30+ years, then all bets are off.

 

[Millard]

Most anti aging experts say TRT will likely shorten your lifespan compared to someone with lower t levels.

Evidence?

I am assuming TRT is referring to maintenance of normal physiologic levels.

 

[Bigboy727]

Evidence?

I am assuming TRT is referring to maintenance of normal physiologic levels.

This is kind of alarming..

Testosterone replacement therapy (TRT) can increase men's risk of stroke and heart attack

Aging men with low testosterone levels who take testosterone replacement therapy (TRT) are at a slightly greater risk of experiencing an ischemic stroke, transient ischemic attack (TIA), or myocardial infarction, especially during the first two years of use, reports a new study. The findings...

www.sciencedaily.com

 

[All Nats McGee]

Evidence?

I am assuming TRT is referring to maintenance of normal physiologic levels.

There’s a lot of studies on castrated dogs and mice about them living longer. Maybe one of the reasons why woman live longer too. Here’s one on humans:

The lifespan of Korean eunuchs

Although many studies have shown that there are trade-offs between longevity and reproduction, whether such trade-offs exist in humans has been a matt…

www.sciencedirect.com

We need longer studies and basically 50 more years to see if TRT is detrimental to living a long time. We know it’s not detrimental to having a good time lol

 

[grey]

I'm not sure I would agree that it is safer to wait and use AAS when you are older than younger. Of course, if death is an outcome, then obviously it's better to wait until your later years.

Oh, I definitely agree that is is not safer. I should have worded my reply more carefully, I don't mean to suggest AAS use is safe at my age, especially not in the dosages used on thsi forum etc.

I am simply saying that for some the compression of morbidity is worth the offsetting loss of several years at the end of the lifestyle qualitatively.

I am assuming TRT is referring to maintenance of normal physiologic levels.

I am not sure that TRT is standardized very well across practices.

My TRT doc keeps me within normal levels... if I was a 15 year old male it would be normal anyway (1100 to 1500 is his target range).

Other TRT docs seem to think that just edging a patient up into the low 500's is the way to go.

This casts a ton of doubt into my mind when we see TRT studies with literally ANY conclusions.

This is kind of alarming..

Eh... not so much:

"15,401 men, aged 45 years or older, with low testosterone levels (hypogonadism). Users of TRT had a 21 percent greater risk of cardiovascular events compared with nonusers, corresponding to an additional 128 events."

"The increased risk appears to be transient, declining after two years of TRT use"


So in conclusion tiny fraction of the 15k+ men (.831 % of them, do the math if you don't believe me) may have had a cardiac or stroke event due to TRT but that already statistically insignificant fraction disappears after the first 2 years of TRT.

There is no meat on that burger.

Note the use of the much scarier sounding "28 percent" increase in total event quantity instead of the actual incidence per capita from the study. Also note the total lack of categorization of event severity etc.

This is just another example of garbage paper writing looking for a link, a headline, and some more grant money.

You see this shit in physical therapy and "exercise" studies too. Roughly 100% are totally useless scientody.

 

[malfeasance]

lets us know when 1 and 4 bodybuilders die of heart failure in one year.

LOL! Dude, slow down and think carefully for a little before reaching your conclusions. 1 in 4 Americans (82 million people) did not die of heart attacks! LOL!

It is one in four deaths, according to what you posted. Guess what? Heart disease is by far the leading cause of death for bodybuilders.

Pay attention, carefully consider, then post. Don't just react and post the first frivolous shit that pops into your head.

You may or may not have a valid point, but you won't know until you apply a little thought to what you are reading.

 

[malfeasance]

Oh, I definitely agree that is is not safer. I should have worded my reply more carefully, I don't mean to suggest AAS use is safe at my age, especially not in the dosages used on thsi forum etc.

I am simply saying that for some the compression of morbidity is worth the offsetting loss of several years at the end of the lifestyle qualitatively.


I am not sure that TRT is standardized very well across practices.

My TRT doc keeps me within normal levels... if I was a 15 year old male it would be normal anyway (1100 to 1500 is his target range).

Other TRT docs seem to think that just edging a patient up into the low 500's is the way to go.

This casts a ton of doubt into my mind when we see TRT studies with literally ANY conclusions.



Eh... not so much:

"15,401 men, aged 45 years or older, with low testosterone levels (hypogonadism). Users of TRT had a 21 percent greater risk of cardiovascular events compared with nonusers, corresponding to an additional 128 events."

"The increased risk appears to be transient, declining after two years of TRT use"


So in conclusion tiny fraction of the 15k+ men (.831 % of them, do the math if you don't believe me) may have had a cardiac or stroke event due to TRT but that already statistically insignificant fraction disappears after the first 2 years of TRT.

There is no meat on that burger.

Note the use of the much scarier sounding "28 percent" increase in total event quantity instead of the actual incidence per capita from the study. Also note the total lack of categorization of event severity etc.

This is just another example of garbage paper writing looking for a link, a headline, and some more grant money.

You see this shit in physical therapy and "exercise" studies too. Roughly 100% are totally useless scientody.

That study you cite compares TRT to non-TRT, which would include high and normal testosterone people.

It should instead compare TRT to a LOW testosterone cohort.

There is a clear link between low testosterone and cardiovascular events and all cause mortality.

Testosterone and the Heart - PMC

Testosterone (T) has a number of important effects on the cardiovascular system. In men, T levels begin to decrease after age 40, and this decrease has been associated with an increase in all-cause mortality and cardiovascular (CV) risk. Low T ...

www.ncbi.nlm.nih.gov

 

[Michael Scally MD]

[OA] Cardiovascular and Cerebrovascular Safety of Testosterone Therapy

To the Editor:

We read with great interest the study by Loo et al1 concerning testosterone (T) therapy increasing the risk of cerebral and cardiovascular disease. Cardiovascular and Cerebrovascular Safety of Testosterone Replacement Therapy Among Aging Men with Low Testosterone Levels: A Cohort Study - ScienceDirect

Unfortunately, the authors’ conclusions are not supported by the results, raising serious concerns. Here we highlight some of these concerns:

1. The single most important finding of this study is that almost twice as many men in the untreated group DIED vs the treatment group, in agreement with previous studies. If we were to counsel a symptomatic hypogonadal patient based on this study and the results of the T trials, we would advise him that T therapy will improve sexual function, walking distance, mood, bone mineral density, anemia, lean muscle mass, insulin sensitivity, and significantly increase his chances of being alive in 5-10 years’ time.

A major critical confounder, inadequately recognized by authors, is that T deficiency itself is a risk for increased cardiovascular events. For this reason, some investigators have elected to censor major adverse cardiovascular events during the first 12 months because those events may be related to the underlying condition rather than T treatment. Failing to take measures like this may account for differences in results between studies. Considerable published data contradict the findings of this study.

2. A careful look at the crude hazard ratios reported in Tables 2-4 suggests that there were no significant statistical differences between the treated and nontreated groups, except in Table 4, where all-cause mortality was significantly reduced in the treated group when compared with both the nontreated group and the “past use” group. The absence of statistically significant results was surprising, because the sample sizes are quite large.

Examining the forest plot, it is clear that there is a lot of variability in the estimates, and even with the large sample size, the authors did not claim any significant differences and most importantly, if these differences are clinically important. There appears to be a lack of evidence of probable clinical significance.

3. It is disturbing that the authors had a preconceived view that only men with classical hypogonadism should be treated, yet they present no evidence as to how results from a “classical” cohort would have been different from those men with nonclassical hypogonadism. On the contrary, the benefits from the T trial were seen in men with “functional” hypogonadism.

4. The authors dismissed symptoms of hypogonadism as due to “aging” and suggested that these symptoms should be tolerated, even for men in their 50s. If this were the case, then hypertension, cataracts, retinal degeneration, and hearing loss should be left untreated and accepted as a consequence of aging.

In addition, the inclusion of a comparative cohort taking 5α-reductase inhibitors is completely irrelevant and bears no basis for comparison. The authors appeared to have preconceived views and seem determined to ensure that their findings are interpreted to fit these views.

Traish AM, Hackett G, Miner M, Morgentaler A. Cardiovascular and Cerebrovascular Safety of Testosterone Therapy. Am J Med 2019. https://www.amjmed.com/article/S0002-9343(19)30433-4/fulltext

 

[takkix]

uhmm how do we prevent this?

Get your heart checked by a cardiologist incl echocardiogram. Doesn't have to be very often but never checking it isn't good.

Don't accept that your blood lipids are trash just because you are on cycle. Do something to get them as good as possible --> Health Supplements, and maybe medications. Fish Oil, maybe garlic extract, red yeast rice, vitamin d3, vitamin k2, coenzyme q10(read yeast rice contains a natural statin called monacolin k) or even take real statins before letting your lipids be trash.

Keep your blood pressure in a fine range. High blood pressure increases your cardiac risk and also other problems like with the kidneys

Do your cardio, eat pretty good, keep stress as low as possible and try to not use harsh compounds every cycle(tren, clen... - maybe use albuterol instead of clen).

Also i would definitely avoid Equipoise. It can be really bad for your heart

 

[grey]

That study you cite

I didn't cite it, it was cited as evidentiary higher in the thread, but it isn't.

It should instead compare TRT to a LOW testosterone cohort.

I concur wholeheartedly but most studies already have their narrative set (Anti-aging for males bad, TRT bad, fire bad) well in advance of doing anything.

There is a clear link between low testosterone and cardiovascular events and all cause mortality.

Testosterone and the Heart

Nice link...

While I WANT to agree here, the link is not a study itself but rather a paper that is loosely a meta-study of other studies.... BUT....

The authors are citing only the studies that indicate THEIR preferred narrative (TRT good, fire bad) while not including anything which might be contra-indicative. That isn't great science.

When papers and studies reinforce my desires and preconceptions they actually need to be scrutinized even more closely.

Maybe one of these days when I am on one of my nootropic cycles I will find time to analyze all 40 of the studies they cited for potential issues

 

[grey]

4. The authors dismissed symptoms of hypogonadism as due to “aging” and suggested that these symptoms should be tolerated, even for men in their 50s.

Nicely summed up. That attitude that "aging" is fine (but only in men!) is so damn common with these studies.