By Richard Knox
Anabolic steroids not only build muscle but ravage livers, increase "bad" cholesterol, hike blood pressure and shrink testicles. The effects on the heart, however, have been debatable.
"No matter how we measured it, we saw the same picture -- namely, that the heart doesn't squeeze as well after it's been exposed to long-term steroids," says Dr. Aaron Baggish of Massachusetts General Hospital.
After an average of nine years on steroids, Baggish says, the cardiac damage was "profound." Users reported weekly doses of around 675 milligrams of "testosterone-equivalent" steroids.
Steroid-users' hearts were also stiffer -- they didn't relax fully between beats. So the main pumping chamber of the heart didn't fill with oxygenated blood from the lungs as completely as it should before the next contraction.
The study, in the current issue of the journal Circulation: Heart Failure, is small. It involves only a dozen steroid-using body builders, compared with seven others, closely matched in age, training level, body mass index and other traits, who said they didn't dope.
Ten of the 12 steroid-users had abnormally low cardiac output, versus none of the non-users.
But Baggish, a cardiologist, and his colleagues say it would be a mistake to discount the findings because of the small number of subjects. For one thing, small comparison groups most likely lead to false negative, not false positive results. That is, a small study is more likely to miss something that's really there than to find something that's not.
"Small studies almost never reach statistical significance," he points out. "When we saw how striking the difference between the two groups was, we realized we had hit on something pretty important."
And how could the researchers be sure these bodybuilders were telling the truth about their steroid use?
"Excellent question," Baggish says. "Truthfully, you can't be 100 percent certain that steroid use was as much or as little as they said."
But he points out that if the athletes the researchers classified as non-users actually did use steroids, "you'd see a lot less of a difference between the groups than we found."
Baggish says that although the "data beg for a larger study, the finding is pretty clear that there's a problem."
The National Institute on Drug Abuse agrees."Despite the small size of the study...its results are important because they reinforce the long-held suspicion that steroid abusers put their cardiovascular system at risk of failure," NIDA director Dr. Nora Volkow says in an email comment. NIDA is considering a grant application from the Harvard group to do a bigger study.
Baggish says the current situation with steroid use reminds him of smoking in the 1950s, before a large enough number of people had been smoking long enough for the public health implications to be evident.
"Our concern with steroids is that we're going to start to see these people who were in their 20s and 30s using heavily back in the '90s now reaching the second half of their lives," Baggish says. "And this is now going to become a real issue."