European Heart Journal – Cardiovascular Imaging (EHJ-CVI)Cardiovascular Effects of Continued vs. Discontinued Anabolic–Androgenic Steroid Use: A Longitudinal Follow-Up Study

⚠️ Small Study / Early Comparative Evidence

Investigators repeated echocardiography after approximately six to seven years in 70 current or former anabolic-androgenic steroid users and 35 nonusing weightlifting controls. Continued users had persistent left ventricular hypertrophy and systolic dysfunction, with worsening diastolic measures despite substantially reduced weekly AAS exposure. Participants who discontinued use demonstrated lower LV mass and improved systolic function. The longitudinal pattern supports potential reversibility after cessation, but small self-selected groups and nonrandomized exposure changes limit causal interpretation.

Clinical Considerations

• Continued users had persistent LVMI of 119 g/m² and mean LVEF of 48%, alongside worsening diastolic measurements.
• Among continued users, 17% had LVEF of 40% or lower, and 46% had LVEF between 41% and 49%.
• Discontinuation was associated with a 21-g/m² reduction in LVMI, a 6-point LVEF increase, and improved global longitudinal strain.
• Participants maintaining longer-term abstinence had cardiac measurements that more closely approached those of nonusing weightlifting controls.
• Active AAS use remained associated with adverse LV mass and systolic-function changes in adjusted analyses.
• Antihypertensive treatment accompanied more favorable systolic changes, but treatment allocation was nonrandomized and available only at follow-up.

Practice Applications

• Recognize continued supraphysiologic AAS exposure as an important consideration when unexplained LV hypertrophy or dysfunction appears in strength-trained patients.
• Discuss cessation as the central modifiable exposure while clarifying that the timing and completeness of myocardial recovery remain uncertain.
• Evaluate cardiac symptoms and abnormal imaging findings within the broader context of blood pressure, stimulant exposure, training, and other cardiovascular risks.
• Avoid interpreting the antihypertensive subgroup as evidence that medication offsets the myocardial effects of continued AAS use.
• Monitor future prospective studies addressing recovery trajectories and management of AAS-associated LV dysfunction.