Anabolic Steroid Exposure Associated With Adverse Cardiovascular Events in Athletes

Results from a new cross-sectional study out of Denmark demonstrate that cumulative anabolic androgenic steroid (AAS) use in male and female recreational athletes was associated with impaired ventricular function and adverse cardiovascular outcomes, supporting measures to prevent their use in sports.¹

Why is Anabolic Steroid Use Scrutinized?

Steroid use in athletes has been present for decades. Anabolic steroids differ from corticosteroids in that they work to produce the androgen testosterone rather than the inflammation-fighting hormone cortisol featured in drugs like prednisone. Testosterone levels are naturally higher in men and stimulate the development of male characteristics, according to Cleveland Clinic.^2,3

Although AAS’ are often prescribed for legitimate health purposes, such as to treat male hypogonadism or stimulate muscle growth in patients with cancer, misuse among athletes has been made famous. Despite the prevalence of AAS misuse in athletes being relatively low—one meta-analysis found a global lifetime rate of 3.3%—there is an immense and widely documented risk of adverse outcomes with long-term intake.^4,5

The research space examining the association between AAS use in athletes and coronary artery disease has primarily stemmed from small observational studies and case reports. Larger studies have substantiated those observations, especially the association between coronary artery plaque volume and AAS use duration, but there remains limited available data on peripheral artery disease in this population. There are also disproportionate demographics in these studies, with data deriving mainly from men rather than women.^1,6

To ameliorate these literature gaps, the authors conducted a study of cardiovascular status in a cohort of Danish male and female athletes using AAS and compared their findings to those from athletes not using AAS. They sought to assess peripheral artery plaque formation through key indicators, including vascular ultrasonography, coronary artery calcification (CAC), and coronary noncalcified plaques (NPCs).¹

What Associations Between AAS Use and Cardiovascular Outcomes Were Found?

Data from the Fitness Doping in Denmark (FIDO-DK) Study, a nationwide cross-sectional cohort analysis, was utilized, specifically from Odense University Hospital in Denmark. In total, 164 participants were included in the study of which 106 [64.6%] had ever used AAS. Eighty (48.8%) were active AAS users (61 men, 19 women; median age, 35 years), 26 were previous users (18 men, 8 women; median age, 36 years), and 58 were healthy nonusers (42 men, 16 women; median age, 40 years).¹

Irrespective of whether they were active or previous users, men had a longer lifetime duration of AAS use than women. Systolic blood pressure was at elevated levels in active AAS users compared with previous users and nonusers, while among active AAS users, there was a higher prevalence of current smokers.¹

Measures of atherosclerosis were taken by the researchers. There were no group differences found in artery plaques or CAC scores between active users and nonusers, whereas a statistically significant difference in the prevalence of coronary NPCs was found. Furthermore, univariable and multivariable logistic regression analyses revealed that cumulative AAS use was associated with a positive CAC score (multivariable odds ratio [OR]: 1.23 [95% CI, 1.09—1.39]; P = .001) and the presence of coronary NPCs (multivariable OR: 1.17 [95% CI, 1.05—1.30]; P = .004).¹

Once adjustments for age and sex were made, increased odds of a positive CAC score were associated with more than 3 years, more than 5 years, and more than 10 years of AAS use, but not with more than 4 years.¹

These insights provide new background into the risks of long-term AAS use in athletes. Pharmacists and health care providers can play an integral role for both younger and older athletes in discouraging AAS use. Because long-term use is associated with especially poor cardiovascular outcomes, pharmacists should counsel patients who are prescribed AAS for legitimate health purposes on the benefits of stewardship and appropriate dosing and administration.¹

REFERENCES

1. Buhl LF, Christensen LL, Hjortebjerg R, et al. Illicit anabolic steroid use and cardiovascular status in men and women. JAMA Netw Open. 2025;8(8):e2526636. doi:10.1001/jamanetworkopen.2025.26636

2. Anabolic steroids. Cleveland Clinic. Last reviewed February 7, 2023. Accessed October 28, 2023. https://my.clevelandclinic.org/health/treatments/5521-anabolic-steroids

3. Miller K. Bulk up your steroid smarts. WebMD. Published June 17, 2025. Accessed October 28, 2025. https://www.webmd.com/a-to-z-guides/ss/slideshow-steroids-101

4. Phil DSM, Molde H, Andreassen CS, et al. The global epidemiology of anabolic-androgenic steroid use: a meta-analysis and meta-regression analysis. Annals Epidemiol. 2014;24(5):383-398. doi:10.1016/j.annepidem.2014.01.009

5. Mathiasen-Windfeld J, Heerfordt IM, Dalhoff KP, et al. Mortality among users of anabolic steroids. JAMA. 2024;331(14):1229-1230. doi:10.1001/jama.2024.3180

6. Baggish AL, Weiner RB, Kanayama G, et al. Cardiovascular toxicity of illicit anabolic-androgenic steroid use. Circulation. 2017;135(21). doi:10.1161/CIRCULATIONAHA.116.026945