Homocysteine induced cardiovascular events: a consequence of long term anabolic-androgenic steroid (AAS) abuse

• Published in: British journal of sports medicine Vol. 40; no. 7; pp. 644 - 648
• Main Authors: Graham, M R, Grace, F M, Boobier, W, Hullin, D, Kicman, A, Cowan, D, Davies, B, Baker, J S
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd and British Association of Sport and Exercise Medicine 01.07.2006; BMJ Publishing Group LTD; BMJ Publishing Group; BMJ Group
• Subjects: AAS; AAS abstinent subjects; AAS using subjects; Adult; Anabolic Agents - adverse effects; Anabolic Agents - pharmacology; anabolic-androgenic steroid; Analysis of Variance; B12; Body mass index; Bodybuilding; bodybuilding controls; Cardiovascular disease; Cardiovascular Diseases - blood; Cardiovascular Diseases - chemically induced; Doping in Sports; FAI; fat free mass; fat free mass index; FFM; FFMI; free androgen index; haematocrit; HCT; HCY; Health risk assessment; homocysteine; Homocystine - blood; Hormones; Humans; Long term; Male; Middle Aged; Mortality; Original; reactive oxygen species; Risk Factors; ROS; sedentary controls; sex hormone binding globulin; SHBG; Side effects; Sports medicine; standard deviation; Steroids; Steroids - adverse effects; Steroids - pharmacology; Substance-Related Disorders - complications; T/E; TBM; testosterone/epitestosterone; tHCY; thromboembolism; total body mass; total HCY; vitamin B12; Weight Lifting
• ISSN: 0306-3674; 1473-0480; 1473-0480
• DOI: 10.1136/bjsm.2005.025668

Objectives: The long term effects (>20 years) of anabolic-androgenic steroid (AAS) use on plasma concentrations of homocysteine (HCY), folate, testosterone, sex hormone binding globulin (SHBG), free androgen index, urea, creatinine, haematocrit (HCT), vitamin B12, and urinary testosterone/epitestosterone (T/E) ratio, were examined in a cohort of self-prescribing bodybuilders. Methods: Subjects (n = 40) were divided into four distinct groups: (1) AAS users still using AAS (SU; n = 10); (2) AAS users abstinent from AAS administration for 3 months (SA; n = 10); (3) non-drug using bodybuilding controls (BC; n = 10); and (4) sedentary male controls (SC; n = 10). Results: HCY levels were significantly higher in SU compared with BC and SC (p<0.01), and with SA (p<0.05). Fat free mass was significantly higher in both groups of AAS users (p<0.01). Daily energy intake (kJ) and daily protein intake (g/day) were significantly higher in SU and SA (p<0.05) compared with BC and SC, but were unlikely to be responsible for the observed HCY increases. HCT concentrations were significantly higher in the SU group (p<0.01). A significant linear inverse relationship was observed in the SU group between SHBG and HCY (r = −0.828, p<0.01), indicating a possible influence of the sex hormones in determining HCY levels. Conclusions: With mounting evidence linking AAS to adverse effects on some clotting factors, the significantly higher levels of HCY and HCT observed in the SU group suggest long term AAS users have increased risk of future thromboembolic events.