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Bodybuilders who use PEDs often don’t have a clear handle on the effects of steroid use on heart attack risk.
These drugs are synthetically produced drugs that mimic the naturally-occurring testosterone.
We’ve entered a day and age where anabolic steroids are becoming more prevalent outside of elite athletic circles.
Today, steroids are used by everyone from mixed martial artists to boxers, from weight lifters to ameteur althletes.
Some of these athletes are under the age of 25-years old, driven by societal pressures to increase bulk muscle mass.
What’s more concerning is that anabolic steroid use, particularly over the long term, has been linked with several life-threatening side effects.
These include hypogonadism, testicular atrophy, impaired spermatogenesis, gynaecomastia, and psychiatric disturbance.
But perhaps the most concerning is the negative effects of steroid use on the cardiovascular system, which often lead to an increased risk of heart attack and stroke.
Steroid Use & Heart Attack Risk
There is a considerable amount of scientific research compiled on the damaging effects of long-term steroid usage.
To date, the vast majority of this research suggests that heart attacks and strokes may be largely underreported.
This is at least partly because patients often don’t develop cardiovascular damage until many years following their steroid use.
For instance, a 2010 study conducted by Harvard Medical School and Massachusetts General Hospital monitored the effects of decade-long steroid use on middle-aged weight lifters.
Study findings revealed evidence of significant damage to the cardiovascular system.
The same damage wasn’t detected in weight lifters who reported no steroid use. Harvard researchers and more claim the studies like this are just the tip of the iceberg when it comes to steroids use and heart attack risk.
Using anabolic steroids over the long term has proven to weaken the heart in the following ways:
Altered Cholesterol Levels
Studies on the impacts of anabolic steroid use, particularly oral steroid use, is linked to cardiovascular disease.
The link is due to the way increasing low-density lipoprotein (or LDL) levels in the blood while decreasing high-density lipoprotein (or HDL) levels.
Lipoproteins are responsible for cholesterol blood transport.
Low HDL paired with high LDL is a main cause of atherosclerosis, which causes fatty deposits to collect in the arteries and impedes blood flow to the heart and brain.
Reduced blood flow to the brain can lead to a stroke while impeded blood flow to the heart can trigger a heart attack.
Some anabolic steroids have been found to produce much greater adverse changes in cholesterol levels, even when taken at lower doses.
Oral anabolic steroids of the C17-alpha alkylated type apparently produce a much greater negative effect when it comes to changes in cholesterol levels.
C17-alpha alkylation (methylation) is a chemical change necessary so that an anabolic steroid can resist hepatic metabolism. This enables high bioavailability through orally administering the anabolic steroid.
This modification also causes an increase in hepatic strain. A 1989 study compared the effects of taking Winstrol (Stanozolol) orally to taking Testosterone orally on cholesterol profiles.
In this study subjects took 6mg a day of Winstrol and other subjects took 200mg of Testosterone a week. After 6 weeks the subjects taking anabolic steroids showed reductions in the good HDL cholesterol of 33% – 71% when taking Winstrol orally. The subjects taking Testosterone orally showed a drop in HDL of just 9%.
The bad LDL cholesterol levels went up by 29% in the subjects that took oral Winstrol, yet the subjects that took Testosterone only saw an increase of 16% in their LDL levels.
The conclusion is that oral steroids are far stronger on the body’s cardiovascular system than using anabolic steroids in an injectable form of compounds that are non-C17-alpha alkylated.
Estrogen is known to positively affect cholesterol profiles, increasing HDL as well as reducing LDL levels.
The challenge for steroid users is that by fending off estrogenic side effects with the use of aromatase inhibitors, which are ancillary compounds, during cycles of anabolic steroid use can cause Estrogen circulating in the system to be lowered to levels considered to be sub-physiological.
In one 12-week clinical trial, Testosterone was shown to have just a mild effect on HDL cholesterol in subjects taking 280mg of Testosterone Enanthate a week.
Then later, after an aromatase inhibitor had been added, the cholesterol profiles became worse, resulting in a 25% drop in HDL levels which is much more significant.
Bodybuilders recommend Estrogen levels be monitored very closely to ensure they do not plunge down so far that they adversely affect cholesterol profiles even more.
Deep Vein Thrombosis
Individuals who use anabolic steroids also increase their risk of deep vein thrombosis (DVT), in which a blood clot forms deep within a vein, causing severe pain and inflammation.
According to the U.S. Federal Drug Administration (FDA), pulmonary embolism can occur when a DVT breaks away and travels through the bloodstream, blocking blood flow to the lungs.
DVT is responsible for roughly 180,000 American deaths annually.
The FDA has also linked testosterone-therapy to a heightened risk of blood clots in male patients with the existing condition, polycythemia.
Patients with polycythemia produce increased red blood cells, which puts them at increased blood clot and pulmonary embolism risk.
Polycythemia is when an individual has an extremely high red blood cell count, well above what is considered normal. This condition is commonly found in all types of athletes, but is particularly present in endurance athletes.
This is caused by the increased demands put on the body for oxygen to be transferred to the muscles. This increases the production of red blood cells since these are the transport mechanism for oxygen throughout the body.
The protein at the center of all red blood cells is called hemoglobin, and this is what oxygen binds to in order to be carried to the tissues needing oxygen. This means that “high hemoglobin” is synonymous with “high red blood cells.”
This results from intense training undertaken on a regular basis so that the red blood cells can carry more oxygen to the muscles during exercise. This in turn requires less effort expended for breathing during physical exertion.
Anabolic steroids stimulate the kidneys, which increases the Erythropoietin (EPO) hormone.
This in turn increases the production of red blood cells as the EPO makes it way to the bone marrow to trigger red blood cell production. This results in higher hemoglobin or red blood cell count in the body.
Polycythemia is the condition whereby there are way too many red blood cells being produced, which can be caused by anabolic steroid use. Users that take anabolic steroids in very high doses or take them for an excessive period of time are felt to be particularly susceptible to polycythemia.
The problem with this condition is in the body’s ability to increase the thickness (viscosity) of the blood and generate high blood pressure.
When the blood becomes too thick, blood circulation can be impaired. The average non-athlete man has a hemoglobin level that ranges from 40.7% – 50.3% and for women; it is usually about 36.1% – 44.3%. Among athletes and bodybuilders who do not use anabolic steroids, their average level of hemoglobin is 45.6%.
A study published in 2006 showed that users of anabolic steroids have on average, a hemoglobin level of 55.7%.
The average red blood cell has a life span of just 120 days. To avoid this polycythemia, bodybuilders recommend that cycles of anabolic steroid use are kept at a reasonable period of time and a good long break is taken between cycles.
It is also recommended that everyone who uses anabolic steroids should have regular blood testing so these factors can be carefully monitored.
If hemoglobin levels rise too high, the recommendation in bodybuilder discussions online is that the steroid use should be immediately stopped and a period of non-steroid use should follow so that the body has time to normalize.
Arrhythmia & Stroke
Long term use of anabolic steroids has long been linked to high blood pressure and left ventricular hypertrophy.
However, a 2016 study conducted by researchers at the University of Birmingham, claims steroids taken by individuals with an inherited heart condition known as arrhythmogenic right ventricular cardiomyopathy (or ARVC), can alter the electrical signals sent to the heart.
This can damage the heart muscle structure, leading to increased risk of atrial fibrillation, the abnormal heart rhythm condition that most often causes a stroke to occur.
A 2017 study out of Massachusetts General Hospital addressed plaque build-up and steroid use.
The study found that long term use of anabolic steroids had greatly compromised overall heart function due to plaque build-up in the arteries.
The study took image tests to monitor the heart function of 140 male weightlifters between 34- and 54-years old, 86 were reported steroid-users while 54 reported no previous steroid use.
The study revealed that steroid users showed significantly more artery plaque build-up compared to non-steroid users. Also of note, was the longer participants reported using steroids—the more arterial plaque build up they experienced.
Since the human heart is made up of muscles, it also has androgen receptors that can be acted on by androgenic anabolic steroids.
Men naturally produce a lot more Testosterone than women do, and men tend to have larger hearts than women do as a result.
Intense exercise and physical training without using anabolic steroids can also lead to the growth of a larger heart. The type of training that one participates in also plays a part in the type of heart enlargement they experience:
- Aerobic Exercise
This describes endurance training, and it causes a condition called eccentric remodeling which is growth in the internal wall of the heart without any growth in the outer walls.
- Anaerobic Exercise
This is a form of resistance or weight training and causes a condition called concentric remodeling, which is a thickening of the outer wall of the heart (ventricles) but without any growth in the internal wall.
Despite these changes in heart growth, it is widely understood that the actual functioning of the heart is not disrupted at all. This suggests that this type of growth in the walls of the heart does not keep the heart from functioning properly (diastolic function).
Moreover, the heart muscle has a way of adapting itself to the level of stimulus, or exercise being provided.
When exercise or training is stopped, the heart in time will begin to become smaller in size. This is typical of all muscle tissue. If the stimulus of exercise is stopped, muscle tissue will eventually atrophy.
Left and right ventricular walls can become broadened with the use of anabolic steroids, especially the left ventricle.
Athletes cycling anabolic steroids have been observed to have a left ventricle that has exceeded a healthy range of growth, leading to complications with the heart. This excessive growth can hobble the productivity and performance of the heart.
Research already exists to show that long term anabolic steroid use can lead to cardiovascular diseases, and in turn heart attack and stroke in users as young as 30-years old.
However, a 2010 study from the American Heart Association links long-term anabolic steroid use to heart impairment dangerous enough to contribute to total heart failure.
The study found that the left ventricle, the muscle that pumps roughly 70-percent of blood from the heart to the rest of the body in healthy individuals, is prone to weakness and failure in steroid users.
To provide context, the study found that steroid users suffered 15-percent decrease in blood pumping from the left ventricle, and increased heart failure risk.
The pressure to get big, lean, strong and fast is overwhelming, and that can drive a lot of people to expose themselves the potentially fatal consequences of steroid use.
But some bodybuilders are finding success with natural steroid alternatives, known colloquially as “legal steroids.”
Legal steroids work in a lot of the same ways that real steroids work.
They promote protein synthesis, help release IGF-1 in the body to aide in muscle repair, and release more oxygen in the blood stream.
The effects will not be as potent as what you get with an anabolic steroid. But in exchange for slower, steadier results, you get to avoid the extremely taxing effects of steroids on your heart.
The link between steroids and heart attacks is a compelling argument for legal steroids.