CLINICAL RESEARCH
Anabolic androgenic steroid users: a tilt test study with young adult men
1
Department of Pharmacy, University Vila Velha, Vila Velha, Brazil
2
Department of Physiological Sciences, Federal University of Espírito Santo, Vitória, Brazil
Submission date: 2019-05-03
Final revision date: 2019-06-28
Acceptance date: 2019-07-04
Publication date: 2019-08-03
Arch Med Sci Civil Dis 2019;4(1):75-83
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Anabolic androgenic steroids (AASs) can induce cardiac dysautonomia, which is related to arrhythmias, vasovagal syncope (VVS) and sudden death. The aim of this study was to determine whether the use of AASs increases the susceptibility for VVS or autonomic dysfunction in AAS users by the head-up tilt test (HUTT).
Material and methods:
Cross-sectional observational study conducted with physically active young men, users (AAS group; n = 10) and non-users (Control group, n = 13) of AAS. The history of physical activity and age of each participant were recorded and the following examinations were performed: physical, biochemical, hormonal, electrocardiogram (ECG), 24-hour Holter recorder equipment. The 24-hour Holter and HUTT were conducted to detect the presence of arrhythmias/heart rate variability, and VVS/dysautonomia, respectively. Of the 28 participants recruited, 5 were excluded for not having completed the examinations.
Results:
Compared with non-users, users of AAS showed an increase in aspartate aminotransferase (Control: 29.7 ±1.8; AAS: 49.9 ±9.0 UI/l; p < 0.05), in ventricular extrasystoles (Control: 2.5 ±2.3; AAS: 14.9 ±11.2, p < 0.05), and reduction in the pNN50 index of Holter (Control: 24.3 ±4.0%; AAS: 14.8 ±4.0%, p < 0.05). The HUTT showed that the maximum value of diastolic blood pressure was increased in the AAS user group (Control: 78.3 ±2.1; AAS: 90.0 ±5.4 mm Hg, p < 0.05).
Conclusions:
The study showed that the use of AAS is able to promote an autonomic dysfunction, with a ventricular arrhythmia. In addition it was found that among AAS users there was a positive result for the HUTT.
Anabolic androgenic steroids (AASs) can induce cardiac dysautonomia, which is related to arrhythmias, vasovagal syncope (VVS) and sudden death. The aim of this study was to determine whether the use of AASs increases the susceptibility for VVS or autonomic dysfunction in AAS users by the head-up tilt test (HUTT).
Material and methods:
Cross-sectional observational study conducted with physically active young men, users (AAS group; n = 10) and non-users (Control group, n = 13) of AAS. The history of physical activity and age of each participant were recorded and the following examinations were performed: physical, biochemical, hormonal, electrocardiogram (ECG), 24-hour Holter recorder equipment. The 24-hour Holter and HUTT were conducted to detect the presence of arrhythmias/heart rate variability, and VVS/dysautonomia, respectively. Of the 28 participants recruited, 5 were excluded for not having completed the examinations.
Results:
Compared with non-users, users of AAS showed an increase in aspartate aminotransferase (Control: 29.7 ±1.8; AAS: 49.9 ±9.0 UI/l; p < 0.05), in ventricular extrasystoles (Control: 2.5 ±2.3; AAS: 14.9 ±11.2, p < 0.05), and reduction in the pNN50 index of Holter (Control: 24.3 ±4.0%; AAS: 14.8 ±4.0%, p < 0.05). The HUTT showed that the maximum value of diastolic blood pressure was increased in the AAS user group (Control: 78.3 ±2.1; AAS: 90.0 ±5.4 mm Hg, p < 0.05).
Conclusions:
The study showed that the use of AAS is able to promote an autonomic dysfunction, with a ventricular arrhythmia. In addition it was found that among AAS users there was a positive result for the HUTT.
REFERENCES (40)
1.
Evans NA. Current concepts in anabolic-androgenic steroids. Am J Sports Med 2004; 32: 534-42.
2.
Lawless CE, Olshansky B, Washington RL, et al. Sports and exercise cardiology in the United States: cardiovascular specialists as members of the athlete healthcare team. J Am Coll Cardiol 2014; 63: 1461-72.
3.
Dunn M, White V. The epidemiology of anabolic–androgenic steroid use among Australian secondary school students. J Sci Med 2011; 14: 10-4.
4.
Maior AS, Carvalho AR, Marques-Neto SR, Menezes P, Soares PP, Nascimento JH. Cardiac autonomic dysfunction in anabolic steroid users. Scand J Med Sci Sports 2013; 23: 548-55.
5.
Sculthorpe N, Grace F, Jones P, Davies B. Evidence of altered cardiac electrophysiology following prolonged androgenic anabolic steroid use. Cardiovasc Toxicol 2010; 10: 239-43.
6.
Maior AS, Menezes P, Pedrosa RC, Carvalho DP, Soares PP, Nascimento JH. Abnormal cardiac repolarization in anabolic androgenic steroid users carrying out submaximal exercise testing. Clin Exp Pharmacol Physiol 2010; 37: 1129-33.
7.
Pereira-Junior PP, Chaves EA, Costa-E-Sousa RH, Masuda MO, de Carvalho AC, Nascimento JH. Cardiac autonomic dysfunction in rats chronically treated with anabolic steroid. Eur J Appl Physiol 2006; 96: 487-94.
8.
Fineschi V, Baroldi G, Monciotti F, et al. Anabolic steroid abuse and cardiac sudden death: a pathologic study. Arch Pathol Lab Med 2001; 125: 253-5.
9.
Achar S, Rostamian A, Narayan SM. Cardiac and metabolic effects of anabolic-androgenic steroid abuse on lipids, blood pressure, left ventricular dimensions, and rhythm. Am J Cardiol 2010; 106: 893-901.
10.
Dickerman RD, Schaller F, Prather I, McConathy WJ. Sudden cardiac death in a 20-year-old bodybuilder using anabolic steroids. Cardiology 1995; 86: 172-3.
11.
Kennedy MC, Laurence C. Anabolic steroid abuse and cardiac death. Med J Aust 1993; 158: 346-8.
12.
Shen MJ, Zipes DP. Role of the autonomic nervous system in modulating cardiac arrhythmias. Circ Res 2014; 114: 1004-21.
13.
Freitas J, Santos RM, Figueiredo V, Teixeira E, Carvalho M, de Freitas AF. Role of autonomic nervous system and hemodynamics in cardiovascular homeostasis after orthostatic stress. Rev Port Cardiol 2000; 19: 1241-74.
14.
Brignole M, Menozzi C, Del Rosso A, et al. New classification of haemodynamics of vasovagal syncope: beyond the VASIS classification. Analysis of the pre-syncopal phase of the tilt test without and with nitroglycerin challenge. Vasovagal Syncope International Study. Europace 2000; 2: 66-76.
15.
Malachias MV, Souza WK, Plavnik FL, et al.; Sociedade Brasileira de Cardiologia; Sociedade Brasileira de Hipertensão; Sociedade Brasileira de Nefrologia. 7th Brazilian Guideline of Arterial Hypertension. Arq Bras Cardiol 2016; 107 (3 Suppl 3): 1-83.
16.
Vanderlei LC, Pastre CM, Hoshi RA, Carvalho TD, Godoy MF. Basic notions of heart rate variability and its clinical applicability. Rev Bras Cir Cardiovasc 2009; 24: 205-17.
17.
Ribeiro JP, Moraes Filho RS. Heart rate variability as an instrument for the investigation of the autonomic nervous system. Rev Bras Hipertens 2005; 12: 14-20.
18.
Benditt DG, Ferguson DW, Grubb BP, et al. Tilt table testing for assessing syncope. American College of Cardiology. J Am Coll Cardiol 1996; 28: 263-75.
19.
Balasubramaniyam N, Palaniswamy C, Aronow WS, et al. Association of corrected QT interval with long-term mortality in patients with syncope. Arch Med Sci 2013; 9: 1049-54.
20.
Moya A, Sutton R, Ammirati F, et al. Guidelines for the diagnosis and management of syncope: the Task Force for the Diagnosis and Management of Syncope of the European Society of Cardiology (ESC). Eur Heart J 2009; 30: 2631-71.
21.
Samoil D, Grubb BP. Vasovagal (neurally-mediated) syncope: pathophysiology, diagnosis and therapeutic approach. Eur J Cardiac Pacing and Electrophysiol 1992; 2: 234-41.
22.
Sutton R, Peterson M, Brignole M, Ravielle A, Menozzi C, Giani P. Proposed classification for tilt induced vasovagal syncope. Eur J Cardiac Pacing Electrophysiol 1992; 2: 180-3.
23.
Owens AP, Low DA, Critchley HD, Mathias CJ. Emotional orienting during interoceptive threat in orthostatic intolerance: dysautonomic contributions to psychological symptomatology in the postural tachycardia syndrome and vasovagal syncope. Auton Neurosci 2018; 212: 42-7.
24.
Gemein C, Roos M, Wolf A, et al. Tilt testing and what you should know about it – experience with 835 consecutive patients with syncope of unknown origin. Int J Cardiol 2018; 258: 90-6.
25.
Kochiadakis GE, Papadimitriou EA, Marketou ME, Chrysostomakis SI, Simantirakis EN, Vardas PE. Autonomic nervous system changes in vasovagal syncope: is there any difference between young and older patients? Pacing Clin Electrophysiol 2004; 27: 1371-7.
26.
Rajendra AU, Paul Joseph K, Kannathal N, Lim CM, Suri JS. Heart rate variability: a review. Med Biol Eng Comput 2006; 44: 1031-51.
27.
Routledge HC, Chowdhary S, Townend JN. Heart rate variability – a therapeutic target? J Clin Pharm Ther 2002; 27: 85-92.
28.
Tsuji H, Larson MG, Venditti FJ Jr, et al. Impact of reduced heart rate variability on risk for cardiac events. The Framingham Heart Study. Circulation 1996; 94: 2850-5.
29.
Marques Neto SR, da H Silva A, dos Santos MC, Ferraz EF, Nascimento JH. The blockade of angiotensin AT1 and aldosterone receptors protects rats from synthetic androgen-induced cardiac autonomic dysfunction. Acta Physiol (Oxf) 2013; 208: 166-71.
30.
Lepiece C, Dormal F, Blommaert D. Vasovagal syncope initiating ventricular fibrillation in a healthy subject. Acta Cardiol 2013; 68: 635-8.
31.
Sucu M, Sari I, Davutoğlu V. A case of prolonged asystole during head-up tilt testing. Turk Kardiyol Dern Ars 2009; 37: 345-7.
32.
Freeman R, Chapleau MW. Testing the autonomic nervous system. Handb Clin Neurol 2013; 115: 115-36.
33.
Nascimento JH, Medei E. Cardiac effects of anabolic steroids: hypertrophy, ischemia and electrical remodelling as potential triggers of sudden death. Mini Rev Med Chem 2011; 11: 425-9.
34.
Brignole M, Alboni P, Benditt DG, et al. Guidelines on management (diagnosis and treatment) of syncope-update 2004. Executive Summary. Eur Heart J 2004; 25: 2054-72.
35.
Gagliano-Jucá T, Içli TB, Pencina KM, et al. Effects of testosterone replacement on electrocardiographic parameters in men: findings from two randomized trials. J Clin Endocrinol Metab 2017; 102: 1478-85.
36.
Schwingel PA, Cotrim HP, Salles BR, et al. Anabolic-androgenic steroids: a possible new risk factor of toxicant-associated fatty liver disease. Liver Int 2011; 31: 348-53.
37.
Modlinski R, Fields KB. The effect of anabolic steroids on the gastrointestinal system, kidneys, and adrenal glands. Curr Sports Med Rep 2006; 5: 104-9.
38.
Conway AJ, Handelsman DJ, Lording DW, Stuckey B, Zajac JD. Use, misuse and abuse of androgens. The Endocrine Society of Australia consensus guidelines for androgen prescribing. Med J Aust 2000; 172: 220-4.
39.
Stimac D, Milić S, Dintinjana RD, Kovac D, Ristić S. Androgenic/anabolic steroid-induced toxic hepatitis. J Clin Gastroenterol 2002; 35: 350-2.
40.
Rosano GM, Cornoldi A, Fini M. Effects of androgens on the cardiovascular system. J Endocrinol Invest 2005; 28 (3 Suppl): 32-8.
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