ARRHYTHMOGENIC EFFECTS OF ANABOLIC STEROIDS: IMPLICATIONS FOR SPORTS CARDIOLOGY
DOI:
https://doi.org/10.56238/levv16n54-180Keywords:
Anabolic Androgenic Steroids, Arrhythmias, Cardiac Remodeling, Sports CardiologyAbstract
Introduction: Anabolic androgenic steroid misuse has become increasingly prevalent among athletes and recreational bodybuilders, raising significant concern regarding its cardiovascular safety. Experimental, clinical, and epidemiological evidence suggests that these substances may induce structural remodeling, autonomic imbalance, and electrical disturbances capable of triggering clinically significant arrhythmias. Understanding the full spectrum of arrhythmogenic effects is essential for guiding screening strategies and improving sports cardiology practice.
Objective: The primary objective of this systematic review was to synthesize current evidence regarding the arrhythmogenic effects of anabolic androgenic steroids. Secondary objectives included evaluating structural, electrophysiological, and autonomic alterations; comparing risk profiles across different steroid regimens; examining mechanistic pathways underlying electrical instability; identifying population-level modifiers of risk; and assessing the methodological quality and certainty of available evidence.
Methods: A comprehensive search was conducted in PubMed, Scopus, Web of Science, Cochrane Library, LILACS, ClinicalTrials.gov, and ICTRP. Studies published within the last decade were eligible, with priority given to human participants and arrhythmia-related outcomes. Two independent reviewers performed study selection and data extraction following PRISMA guidelines. Risk of bias was assessed using validated tools, and certainty of evidence was classified according to the GRADE framework.
Results and Discussion: Twenty studies met the inclusion criteria. Across animal models, clinical cohorts, imaging studies, and mechanistic investigations, consistent evidence demonstrated associations between steroid use and myocardial fibrosis, impaired ventricular function, reduced heart rate variability, repolarization abnormalities, and increased prevalence of supraventricular and ventricular arrhythmias. Although heterogeneity of exposure patterns limited pooled analysis, convergence of structural, autonomic, and electrophysiological findings supports a clinically significant arrhythmogenic risk.
Conclusion: Anabolic androgenic steroid use is associated with substantial arrhythmogenic potential, supported by converging evidence across multiple diagnostic modalities. Routine cardiovascular screening, early detection of subclinical dysfunction, and interdisciplinary management are essential to mitigate preventable arrhythmia-related morbidity and mortality among athletes and recreational users.
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