Do steroids cause heart attacks?

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Do steroids cause heart attacks and how do they impact the heart?

It is well known by most in society that Anabolic steroids impact the heart. They will tell you that if you use steroids your heart will become enormous or that you will have a heart attack. Are they right? What does the science say?

There are multiple different aspects to heart disease, especially in steroid use. So, I will mention every aspect and how it may or may not impact one’s heart.

Do steroids enlarge the heart?
Yes, they do. They achieve this through multiple mechanisms. Human hearts contain androgen receptors and thus grow in response to high androgen levels. Simply training increases the size of the heart, whether it be resistance training (increases heart wall size) or endurance training (increases chamber size). Steroid users experience thickening of the heart wall. While natural bodybuilders also experience thickening, the thickening found in steroid abuse is much greater and impairs the function of the heart. Thickening of the heart wall is associated with heart rhythm problems, sudden collapse, heart attacks and even death.

The size of the heart does decrease when the steroids are stopped. However, dysfunction may persist.

Another contribution to an enlarged heart is the increase in blood pressure that steroids cause. High blood pressure (well reported in steroid abuse) is a risk factor for developing a large heart and eventual heart failure. Therefore, there is more than one way in which steroids enlarge the heart. Prevention will be mentioned in a separate article.

Do steroids damage the heart muscle?
In vitro (Test tube) studies have shown that steroids are directly toxic to the heart. It decreases the contractility of the heart muscle cells. Furthermore, on post-mortem examination of steroid abusers scarring of the heart and heart muscle death has been reported. However, there are multiple other causes of these problems described (such as a diet high in saturated fats) so it is difficult to prove causation.

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Effect on Cholesterol and lipids (fat in the blood)
It is well known in the literature that steroids decrease your good cholesterol (HDL) and in some cases increase you bad cholesterol (LDL) without a change in total cholesterol (oral steroids are more potent at causing this issue which will be expanded upon in a separate article). Therefore, when using steroids, the most important marker to look for is the HDL/LDL ratio. When steroids are stopped, this ratio should correct. The issue is that this abnormal ratio will result is possible plaque deposition in the arteries which could lead to some in the arteries of the heart and result in a heart attack over time.

As a side note, oestrogen converting steroids impact HDL less because of the protective oestrogenic effect.

Other contributory effects are the increase in blood thickness that steroids because which limits blood flow and eventually oxygen to heart muscles and this leads to heart muscle death (heart attack). Furthermore, steroids have been shown to decrease the reactivity of the blood vessels. Blood vessels fail to expand when they need to limiting flow to certain regions (such as the heart) result in cell death.

The problem with linking steroids to heart attacks.
The issue with trying to associate steroid use to heart attacks is that most men are already at high risk and there are multiple other factors that might contribute to heart attacks (such as lifestyle, diet, etc). Furthermore, long-term studies on steroid abuse are limited partly due to the ethical ramifications of such studies. However, to deny that steroids do not cause heart attacks would be foolish due to the mechanistic data accumulated on how it can damage the heart.

In conclusion, steroids do enlarge the heart by a variety of mechanisms outline above. However, there is limited data to prove the link to heart attacks.

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