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Copyright (c) 2022 Claudia Yaneth Rodríguez-Triviño, Sammy Castellanos Rojas, Carlos Andrés Gómez-Coronado, Sergio Andrés Cristancho-Losada
This work is licensed under a Creative Commons Attribution 4.0 International License.
Anabolic androgenic steroids on the young adult electrocardiographic record and heart autonomic control
Corresponding Author(s) : Claudia Yaneth Rodríguez-Triviño
cy.rodriguez@uninavarra.edu.co
Ciencia e Innovación en Salud,
2022
Abstract
The consumption of androgenic steroids has a global prevalence of 6.4% in men and 1.6% in women, it is important to determine the effects of the consumption of anabolic androgenic steroids. This article aims to review myocardial structural and molecular changes produced by anabolic androgenic steroids (AAS) and the electrophysiological complications and other disorders that may occur due to consumption. A non-systematic review of the literature was carried out in the MedLine, LILACS, Clinicalkey and Google Scholar databases. 50 reference articles were included, focused on the objective of this review
In conclusion, AAS use is implicated in multiple life-threatening cardiovascular pathologies. The most frequent changes are associated with cardiac ventricular hypertrophy (VH), a sympathetic predominance that triggers arterial hypertension among other alterations
1.
Rodríguez-Triviño CY, Castellanos Rojas S, Gómez-Coronado CA, Cristancho-Losada SA. Anabolic androgenic steroids on the young adult electrocardiographic record and heart autonomic control. Ciencia e Innovación en Salud [Internet]. 2022 Oct. 25 [cited 2024 Nov. 25];. Available from: https://revistas.unisimon.edu.co/index.php/innovacionsalud/article/view/5140
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References
-
1. Karila T. Adverse effects of anabolic androgenic steroids on the cardiovascular, metabolic and reproductive systems of anabolic substance abusers. 2003;
2. Abuse NI on D. ¿Qué son los esteroides anabólicos? [Internet]. [citado 12 de noviembre de 2019]. Disponible en: https://www.drugabuse.gov/es/publicaciones/serie-de-reportes/abuso-de-los-esteroides-anabolicos/que-son-los-esteroides-anabolicos
3. Iriart JAB, Chaves JC, Orleans RG de. Culto ao corpo e uso de anabolizantes entre praticantes de musculação. Cad Saúde Pública. abril de 2009;25(4):773-82.
4. Melki JP, Hitti EA, Oghia MJ, Mufarrij AA. Media Exposure, Mediated Social Comparison to Idealized Images of Muscularity, and Anabolic Steroid Use. Health Communication. 4 de mayo de 2015;30(5):473-84.
5. Binayi F, Joukar S, Najafipour H, Karimi A, Abdollahi F, Masumi Y. The Effects of Nandrolone Decanoate Along with Prolonged Low-Intensity Exercise on Susceptibility to Ventricular Arrhythmias. Cardiovasc Toxicol. enero de 2016;16(1):23-33.
6. Al Jarallah M, Rajan R, Braikan KA, Dashti R, Elkhouly IM, Kotevski V, et al. Coronary Artery Profile of Young Kuwaiti Males on Anabolic Steroids. Int J Cardiovasc Res [Internet]. 2018 [citado 11 de noviembre de 2019];07(03). Disponible en: https://www.scitechnol.com/peer-review/coronary-artery-profile-of-young-kuwaiti-males-on-anabolic-steroids-DUnj.php?article_id=7958
7. Pope HG, Wood RI, Rogol A, Nyberg F, Bowers L, Bhasin S. Adverse Health Consequences of Performance-Enhancing Drugs: An Endocrine Society Scientific Statement. Endocrine Reviews. 1 de junio de 2014;35(3):341-75.
8. Alfaro JMR, Castillo AÁ, Boza AS. Esteroides anabólicos: repercusiones médicas del uso indiscriminado con fines en la mejora del rendimiento atlético. Revista Medica Sinergia. 2020;5(7):e531-e531.
9. Tofighi A. The effect of nandrolone treatment with and without enforced swimming on histological and biochemical changes in the heart and coronary artery of male rats. Anatol J Cardiol [Internet]. 2017 [citado 13 de noviembre de 2019]; Disponible en: https://www.journalagent.com/anatoljcardiol/pdfs/AJC_17_3_176_183.pdf
10. Luc JG, Buchholz H, Kim DH, MacArthur RG. Left ventricular assist device for ventricular recovery of anabolic steroid-induced cardiomyopathy. Journal of surgical case reports. 2018;2018(8):rjy221.
11. Joukar S, Yoosefnia M, Naderi-Boldaji V, Nasri H, Rafie F. Heart Reaction to Nandrolone Decanoate plus Two Different Intensities of Endurance Exercise: Electrocardiography and Stereological Approach. Addiction and Health [Internet]. 29 de enero de 2019 [citado 12 de noviembre de 2019];10(3). Disponible en: http://doi.org/10.22122/ahj.v10i3.587
12. Long-term treatment with supraphysiological doses of nandrolone decanoate reduces the sensitivity of Bezold-Jarisch reflex control of heart rate an... - PubMed - NCBI [Internet]. [citado 11 de noviembre de 2019]. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/19429469
13. Olivares EL, Silveira ALB, Fonseca FV, Silva-Almeida C, Côrtes RS, Pereira-Junior PP, et al. Administration of an anabolic steroid during the adolescent phase changes the behavior, cardiac autonomic balance and fluid intake in male adult rats. Physiology & Behavior. marzo de 2014;126:15-24.
14. Montalvo C, Villar AV, Merino D, García R, Ares M, Llano M, et al. Androgens Contribute to Sex Differences in Myocardial Remodeling under Pressure Overload by a Mechanism Involving TGF-β. Abbate A, editor. PLoS ONE. 25 de abril de 2012;7(4):e35635.
15. Franquni JVM, do Nascimento AM, de Lima EM, Brasil GA, Heringer OA, Cassaro KO dos S, et al. Nandrolone decanoate determines cardiac remodelling and injury by an imbalance in cardiac inflammatory cytokines and ACE activity, blunting of the Bezold–Jarisch reflex, resulting in the development of hypertension. Steroids. marzo de 2013;78(3):379-85.
16. Guo L, Yin A, Zhang Q, Zhong T, O’Rourke ST, Sun C. Angiotensin-(1–7) attenuates angiotensin II-induced cardiac hypertrophy via a Sirt3-dependent mechanism. American Journal of Physiology-Heart and Circulatory Physiology. 1 de mayo de 2017;312(5):H980-91.
17. Varo N, Etayo JC, Zalba G, Beaumont J, Iraburu MJ, Montiel C, et al. Losartan inhibits the post-transcriptional synthesis of collagen type I and reverses left ventricular fibrosis in spontaneously hypertensive rats: Journal of Hypertension. enero de 1999;17(1):107-14.
18. Dunn FG, Oigman W, Ventura HO, Messerli FH, Kobrin I, Frohlich ED. Enalapril improves systemic and renal hemodynamics and allows regression of left ventricular mass in essential hypertension. The American Journal of Cardiology. enero de 1984;53(1):105-8.
19. Brilla CG, Maisch B, Weber KT. Renin-angiotensin system and myocardial collagen matrix remodeling in hypertensive heart disease: in vivo and in vitro studies on collagen matrix regulation. Clin Investig [Internet]. 1993 [citado 6 de abril de 2020];71(5). Disponible en: http://link.springer.com/10.1007/BF00180074
20. Brilla C. Renin–angiotensin–aldosterone system and myocardial fibrosis. Cardiovascular Research. julio de 2000;47(1):1-3.
21. Cunha TS, José M, Moura CS, Bernardes CF, Tanno AP, Marcondes FK. Vascular Sensitivity to Phenylephrine in Rats Submitted to Anaerobic Training and Nandrolone Treatment. Hypertension. octubre de 2005;46(4):1010-5.
22. Ueta CB, Oskouei BN, Olivares EL, Pinto JR, Correa MM, Simovic G, et al. Absence of Myocardial Thyroid Hormone Inactivating Deiodinase Results in Restrictive Cardiomyopathy in Mice. Molecular Endocrinology. 1 de mayo de 2012;26(5):809-18.
23. Seara F de AC, Barbosa RAQ, de Oliveira DF, Gran da Silva DLS, Carvalho AB, Freitas Ferreira AC, et al. Administration of anabolic steroid during adolescence induces long-term cardiac hypertrophy and increases susceptibility to ischemia/reperfusion injury in adult Wistar rats. The Journal of Steroid Biochemistry and Molecular Biology. julio de 2017;171:34-42.
24. Pirompol P, Teekabut V, Weerachatyanukul W, Bupha-Intr T, Wattanapermpool J. Supra-physiological dose of testosterone induces pathological cardiac hypertrophy. Journal of Endocrinology. abril de 2016;229(1):13-23.
25. Dorn GW, Force T. Protein kinase cascades in the regulation of cardiac hypertrophy. J Clin Invest. 1 de marzo de 2005;115(3):527-37.
26. Eduardo Carreño J, Apablaza F, Paz Ocaranza M, E. Jalil J. Hipertrofia cardiaca: eventos moleculares y celulares. Revista Española de Cardiología. mayo de 2006;59(5):473-86.
27. McMullen JR, Shioi T, Zhang L, Tarnavski O, Sherwood MC, Kang PM, et al. Phosphoinositide 3-kinase(p110α) plays a critical role for the induction of physiological, but not pathological, cardiac hypertrophy. Proc Natl Acad Sci U S A. 14 de octubre de 2003;100(21):12355-60.
28. Altamirano F, Oyarce C, Silva P, Toyos M, Wilson C, Lavandero S, et al. Testosterone induces cardiomyocyte hypertrophy through mammalian target of rapamycin complex 1 pathway. Journal of Endocrinology. agosto de 2009;202(2):299-307.
29. Joukar S, Yoosefnia M, Naderi-Boldaji V, Nasri H, Rafie F. Heart Reaction to Nandrolone Decanoate plus Two Different Intensities of Endurance Exercise: Electrocardiography and Stereological Approach. Addiction & health. 2018;10(3):180.
30. Baumann S, Jabbour C, Huseynov A, Borggrefe M, Haghi D, Papavassiliu T. Myocardial Scar Detected by Cardiovascular Magnetic Resonance in a Competitive Bodybuilder With Longstanding Abuse of Anabolic Steroids. Asian J Sports Med [Internet]. 10 de noviembre de 2014 [citado 11 de noviembre de 2019];5(4). Disponible en: http://asjsm.com/en/articles/21610.html
31. Achar S, Rostamian A, Narayan SM. Cardiac and Metabolic Effects of Anabolic-Androgenic Steroid Abuse on Lipids, Blood Pressure, Left Ventricular Dimensions, and Rhythm. The American Journal of Cardiology. septiembre de 2010;106(6):893-901.
32. Sobrinho CA, Junior WCR, Corsini W, Soares EA, Esteves A. Doses suprafisiológicas de esteroides anabolizantes e os efeitos no coração de ratos jovens sedentários: estudo morfométrico. Research, Society and Development. 2020;9(11):e72091110079-e72091110079.
33. Baumann S, Jabbour C, Huseynov A, Borggrefe M, Haghi D, Papavassiliu T. Myocardial scar detected by cardiovascular magnetic resonance in a competitive bodybuilder with longstanding abuse of anabolic steroids. Asian journal of sports medicine. 2014;5(4).
34. Achar S, Rostamian A, Narayan SM. Cardiac and metabolic effects of anabolic-androgenic steroid abuse on lipids, blood pressure, left ventricular dimensions, and rhythm. The American journal of cardiology. 2010;106(6):893-901.
35. Mewis C, Spyridopoulos I, Kühlkamp V, Seipel L. Manifestation of severe coronary heart disease after anabolic drug abuse. Clin Cardiol. febrero de 1996;19(2):153-5.
36. Heart Reaction to Nandrolone Decanoate plus Two Different Intensities of Endurance Exercise: Electrocardiography and Stereological Approach. - PubMed - NCBI [Internet]. [citado 11 de noviembre de 2019]. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/31105916
37. Baggish AL, Weiner RB, Kanayama G, Hudson JI, Lu MT, Hoffmann U, et al. Cardiovascular toxicity of illicit anabolic-androgenic steroid use. Circulation. 2017;135(21):1991-2002.
38. Sodhi P, Patel MR, Solsi A, Bellamkonda P. Decompensated Non-Ischemic Cardiomyopathy Induced by Anabolic-Androgenic Steroid Abuse. Cureus. 13 de noviembre de 2020;12(11):e11476.
39. Hernández LS. Efectos adversos para la salud inducidos por los esteroides anabolizantes en un grupo controlado de fisioculturistas. :15.
40. Maior AS, Belchior C, Sanches RC, Leonelli T, Schwingel PA, Simão R, et al. Chronic Users of Supraphysiological Doses of Anabolic Androgenic Steroids Develop Hematological and Serum Lipoprotein Profiles That Are Characteristic of High. 2011;3:11.
41. Alizade E, Avcı A, Fidan S, Tabakçı M, Bulut M, Zehir R, et al. The Effect of Chronic Anabolic-Androgenic Steroid Use on Tp-E Interval, Tp-E/Qt Ratio, and Tp-E/Qtc Ratio in Male Bodybuilders: The Effect of Steroid Use on Tp-E Interval and Tp-E/Qt Ratio. Ann Noninvasive Electrocardiol. noviembre de 2015;20(6):592-600.
42. Stolt A, Karila T, Viitasalo M, Mäntysaari M, Kujala UM, Karjalainen J. QT interval and QT dispersion in endurance athletes and in power athletes using large doses of anabolic steroids. The American Journal of Cardiology. agosto de 1999;84(3):364-6.
43. Maior AS, Menezes P, Pedrosa RC, Carvalho DP, Soares PP, Nascimento JHM. Abnormal cardiac repolarization in anabolic androgenic steroid users carrying out submaximal exercise testing: Abnormal repolarization in anabolic steroid users. Clinical and Experimental Pharmacology and Physiology. diciembre de 2010;37(12):1129-33.
44. Barbosa Neto O, da Mota GR, De Sordi CC, Resende EAMR, Resende LAPR, Vieira da Silva MA, et al. Long-term anabolic steroids in male bodybuilders induce cardiovascular structural and autonomic abnormalities. Clin Auton Res. 2018;28(2):231-44.
45. Díaz Conde M, Brito Miranda D, Márquez Villegas FG, Hernández Pliego RR. Paro cardiaco repentino atribuido a miocardiopatía hipertrófica por uso de esteroides anabólicos. Reporte de caso. Medicina crítica (Colegio Mexicano de Medicina Crítica). 2017;31(2):101-5.
46. Pereira-Junior PP, Chaves EA, Costa-e-Sousa RH, Masuda MO, de Carvalho ACC, Nascimento JH. Cardiac autonomic dysfunction in rats chronically treated with anabolic steroid. European journal of applied physiology. 2006;96(5):487-94.
47. de Souza FR, Sales ARK, Dos Santos MR, Porello RA, Fonseca GWP da, Sayegh ALC, et al. Retrograde and oscillatory shear rate in young anabolic androgenic steroid users. Scand J Med Sci Sports. marzo de 2019;29(3):422-9.
48. Maior AS, Carvalho AR, Marques-Neto SR, Menezes P, Soares PP, Nascimento JHM. Cardiac autonomic dysfunction in anabolic steroid users. Scand J Med Sci Sports. octubre de 2013;23(5):548-55.
49. Santos M, Sayegh A, Armani R, Costa-Hong V, Souza F, Toschi-Dias E, et al. Resting spontaneous baroreflex sensitivity and cardiac autonomic control in anabolic androgenic steroid users. Clinics [Internet]. 1 de junio de 2018 [citado 11 de septiembre de 2020];73. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5952050/?report=classic
50. Moreno Sánchez J, Parrado Romero E, Capdevila Ortís L. Variabilidad de la frecuencia cardíaca y perfiles psicofisiológicos en deportes de equipo de alto rendimiento. Revista de psicología del deporte. 2013;22(2):0345-52.
References
1. Karila T. Adverse effects of anabolic androgenic steroids on the cardiovascular, metabolic and reproductive systems of anabolic substance abusers. 2003;
2. Abuse NI on D. ¿Qué son los esteroides anabólicos? [Internet]. [citado 12 de noviembre de 2019]. Disponible en: https://www.drugabuse.gov/es/publicaciones/serie-de-reportes/abuso-de-los-esteroides-anabolicos/que-son-los-esteroides-anabolicos
3. Iriart JAB, Chaves JC, Orleans RG de. Culto ao corpo e uso de anabolizantes entre praticantes de musculação. Cad Saúde Pública. abril de 2009;25(4):773-82.
4. Melki JP, Hitti EA, Oghia MJ, Mufarrij AA. Media Exposure, Mediated Social Comparison to Idealized Images of Muscularity, and Anabolic Steroid Use. Health Communication. 4 de mayo de 2015;30(5):473-84.
5. Binayi F, Joukar S, Najafipour H, Karimi A, Abdollahi F, Masumi Y. The Effects of Nandrolone Decanoate Along with Prolonged Low-Intensity Exercise on Susceptibility to Ventricular Arrhythmias. Cardiovasc Toxicol. enero de 2016;16(1):23-33.
6. Al Jarallah M, Rajan R, Braikan KA, Dashti R, Elkhouly IM, Kotevski V, et al. Coronary Artery Profile of Young Kuwaiti Males on Anabolic Steroids. Int J Cardiovasc Res [Internet]. 2018 [citado 11 de noviembre de 2019];07(03). Disponible en: https://www.scitechnol.com/peer-review/coronary-artery-profile-of-young-kuwaiti-males-on-anabolic-steroids-DUnj.php?article_id=7958
7. Pope HG, Wood RI, Rogol A, Nyberg F, Bowers L, Bhasin S. Adverse Health Consequences of Performance-Enhancing Drugs: An Endocrine Society Scientific Statement. Endocrine Reviews. 1 de junio de 2014;35(3):341-75.
8. Alfaro JMR, Castillo AÁ, Boza AS. Esteroides anabólicos: repercusiones médicas del uso indiscriminado con fines en la mejora del rendimiento atlético. Revista Medica Sinergia. 2020;5(7):e531-e531.
9. Tofighi A. The effect of nandrolone treatment with and without enforced swimming on histological and biochemical changes in the heart and coronary artery of male rats. Anatol J Cardiol [Internet]. 2017 [citado 13 de noviembre de 2019]; Disponible en: https://www.journalagent.com/anatoljcardiol/pdfs/AJC_17_3_176_183.pdf
10. Luc JG, Buchholz H, Kim DH, MacArthur RG. Left ventricular assist device for ventricular recovery of anabolic steroid-induced cardiomyopathy. Journal of surgical case reports. 2018;2018(8):rjy221.
11. Joukar S, Yoosefnia M, Naderi-Boldaji V, Nasri H, Rafie F. Heart Reaction to Nandrolone Decanoate plus Two Different Intensities of Endurance Exercise: Electrocardiography and Stereological Approach. Addiction and Health [Internet]. 29 de enero de 2019 [citado 12 de noviembre de 2019];10(3). Disponible en: http://doi.org/10.22122/ahj.v10i3.587
12. Long-term treatment with supraphysiological doses of nandrolone decanoate reduces the sensitivity of Bezold-Jarisch reflex control of heart rate an... - PubMed - NCBI [Internet]. [citado 11 de noviembre de 2019]. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/19429469
13. Olivares EL, Silveira ALB, Fonseca FV, Silva-Almeida C, Côrtes RS, Pereira-Junior PP, et al. Administration of an anabolic steroid during the adolescent phase changes the behavior, cardiac autonomic balance and fluid intake in male adult rats. Physiology & Behavior. marzo de 2014;126:15-24.
14. Montalvo C, Villar AV, Merino D, García R, Ares M, Llano M, et al. Androgens Contribute to Sex Differences in Myocardial Remodeling under Pressure Overload by a Mechanism Involving TGF-β. Abbate A, editor. PLoS ONE. 25 de abril de 2012;7(4):e35635.
15. Franquni JVM, do Nascimento AM, de Lima EM, Brasil GA, Heringer OA, Cassaro KO dos S, et al. Nandrolone decanoate determines cardiac remodelling and injury by an imbalance in cardiac inflammatory cytokines and ACE activity, blunting of the Bezold–Jarisch reflex, resulting in the development of hypertension. Steroids. marzo de 2013;78(3):379-85.
16. Guo L, Yin A, Zhang Q, Zhong T, O’Rourke ST, Sun C. Angiotensin-(1–7) attenuates angiotensin II-induced cardiac hypertrophy via a Sirt3-dependent mechanism. American Journal of Physiology-Heart and Circulatory Physiology. 1 de mayo de 2017;312(5):H980-91.
17. Varo N, Etayo JC, Zalba G, Beaumont J, Iraburu MJ, Montiel C, et al. Losartan inhibits the post-transcriptional synthesis of collagen type I and reverses left ventricular fibrosis in spontaneously hypertensive rats: Journal of Hypertension. enero de 1999;17(1):107-14.
18. Dunn FG, Oigman W, Ventura HO, Messerli FH, Kobrin I, Frohlich ED. Enalapril improves systemic and renal hemodynamics and allows regression of left ventricular mass in essential hypertension. The American Journal of Cardiology. enero de 1984;53(1):105-8.
19. Brilla CG, Maisch B, Weber KT. Renin-angiotensin system and myocardial collagen matrix remodeling in hypertensive heart disease: in vivo and in vitro studies on collagen matrix regulation. Clin Investig [Internet]. 1993 [citado 6 de abril de 2020];71(5). Disponible en: http://link.springer.com/10.1007/BF00180074
20. Brilla C. Renin–angiotensin–aldosterone system and myocardial fibrosis. Cardiovascular Research. julio de 2000;47(1):1-3.
21. Cunha TS, José M, Moura CS, Bernardes CF, Tanno AP, Marcondes FK. Vascular Sensitivity to Phenylephrine in Rats Submitted to Anaerobic Training and Nandrolone Treatment. Hypertension. octubre de 2005;46(4):1010-5.
22. Ueta CB, Oskouei BN, Olivares EL, Pinto JR, Correa MM, Simovic G, et al. Absence of Myocardial Thyroid Hormone Inactivating Deiodinase Results in Restrictive Cardiomyopathy in Mice. Molecular Endocrinology. 1 de mayo de 2012;26(5):809-18.
23. Seara F de AC, Barbosa RAQ, de Oliveira DF, Gran da Silva DLS, Carvalho AB, Freitas Ferreira AC, et al. Administration of anabolic steroid during adolescence induces long-term cardiac hypertrophy and increases susceptibility to ischemia/reperfusion injury in adult Wistar rats. The Journal of Steroid Biochemistry and Molecular Biology. julio de 2017;171:34-42.
24. Pirompol P, Teekabut V, Weerachatyanukul W, Bupha-Intr T, Wattanapermpool J. Supra-physiological dose of testosterone induces pathological cardiac hypertrophy. Journal of Endocrinology. abril de 2016;229(1):13-23.
25. Dorn GW, Force T. Protein kinase cascades in the regulation of cardiac hypertrophy. J Clin Invest. 1 de marzo de 2005;115(3):527-37.
26. Eduardo Carreño J, Apablaza F, Paz Ocaranza M, E. Jalil J. Hipertrofia cardiaca: eventos moleculares y celulares. Revista Española de Cardiología. mayo de 2006;59(5):473-86.
27. McMullen JR, Shioi T, Zhang L, Tarnavski O, Sherwood MC, Kang PM, et al. Phosphoinositide 3-kinase(p110α) plays a critical role for the induction of physiological, but not pathological, cardiac hypertrophy. Proc Natl Acad Sci U S A. 14 de octubre de 2003;100(21):12355-60.
28. Altamirano F, Oyarce C, Silva P, Toyos M, Wilson C, Lavandero S, et al. Testosterone induces cardiomyocyte hypertrophy through mammalian target of rapamycin complex 1 pathway. Journal of Endocrinology. agosto de 2009;202(2):299-307.
29. Joukar S, Yoosefnia M, Naderi-Boldaji V, Nasri H, Rafie F. Heart Reaction to Nandrolone Decanoate plus Two Different Intensities of Endurance Exercise: Electrocardiography and Stereological Approach. Addiction & health. 2018;10(3):180.
30. Baumann S, Jabbour C, Huseynov A, Borggrefe M, Haghi D, Papavassiliu T. Myocardial Scar Detected by Cardiovascular Magnetic Resonance in a Competitive Bodybuilder With Longstanding Abuse of Anabolic Steroids. Asian J Sports Med [Internet]. 10 de noviembre de 2014 [citado 11 de noviembre de 2019];5(4). Disponible en: http://asjsm.com/en/articles/21610.html
31. Achar S, Rostamian A, Narayan SM. Cardiac and Metabolic Effects of Anabolic-Androgenic Steroid Abuse on Lipids, Blood Pressure, Left Ventricular Dimensions, and Rhythm. The American Journal of Cardiology. septiembre de 2010;106(6):893-901.
32. Sobrinho CA, Junior WCR, Corsini W, Soares EA, Esteves A. Doses suprafisiológicas de esteroides anabolizantes e os efeitos no coração de ratos jovens sedentários: estudo morfométrico. Research, Society and Development. 2020;9(11):e72091110079-e72091110079.
33. Baumann S, Jabbour C, Huseynov A, Borggrefe M, Haghi D, Papavassiliu T. Myocardial scar detected by cardiovascular magnetic resonance in a competitive bodybuilder with longstanding abuse of anabolic steroids. Asian journal of sports medicine. 2014;5(4).
34. Achar S, Rostamian A, Narayan SM. Cardiac and metabolic effects of anabolic-androgenic steroid abuse on lipids, blood pressure, left ventricular dimensions, and rhythm. The American journal of cardiology. 2010;106(6):893-901.
35. Mewis C, Spyridopoulos I, Kühlkamp V, Seipel L. Manifestation of severe coronary heart disease after anabolic drug abuse. Clin Cardiol. febrero de 1996;19(2):153-5.
36. Heart Reaction to Nandrolone Decanoate plus Two Different Intensities of Endurance Exercise: Electrocardiography and Stereological Approach. - PubMed - NCBI [Internet]. [citado 11 de noviembre de 2019]. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/31105916
37. Baggish AL, Weiner RB, Kanayama G, Hudson JI, Lu MT, Hoffmann U, et al. Cardiovascular toxicity of illicit anabolic-androgenic steroid use. Circulation. 2017;135(21):1991-2002.
38. Sodhi P, Patel MR, Solsi A, Bellamkonda P. Decompensated Non-Ischemic Cardiomyopathy Induced by Anabolic-Androgenic Steroid Abuse. Cureus. 13 de noviembre de 2020;12(11):e11476.
39. Hernández LS. Efectos adversos para la salud inducidos por los esteroides anabolizantes en un grupo controlado de fisioculturistas. :15.
40. Maior AS, Belchior C, Sanches RC, Leonelli T, Schwingel PA, Simão R, et al. Chronic Users of Supraphysiological Doses of Anabolic Androgenic Steroids Develop Hematological and Serum Lipoprotein Profiles That Are Characteristic of High. 2011;3:11.
41. Alizade E, Avcı A, Fidan S, Tabakçı M, Bulut M, Zehir R, et al. The Effect of Chronic Anabolic-Androgenic Steroid Use on Tp-E Interval, Tp-E/Qt Ratio, and Tp-E/Qtc Ratio in Male Bodybuilders: The Effect of Steroid Use on Tp-E Interval and Tp-E/Qt Ratio. Ann Noninvasive Electrocardiol. noviembre de 2015;20(6):592-600.
42. Stolt A, Karila T, Viitasalo M, Mäntysaari M, Kujala UM, Karjalainen J. QT interval and QT dispersion in endurance athletes and in power athletes using large doses of anabolic steroids. The American Journal of Cardiology. agosto de 1999;84(3):364-6.
43. Maior AS, Menezes P, Pedrosa RC, Carvalho DP, Soares PP, Nascimento JHM. Abnormal cardiac repolarization in anabolic androgenic steroid users carrying out submaximal exercise testing: Abnormal repolarization in anabolic steroid users. Clinical and Experimental Pharmacology and Physiology. diciembre de 2010;37(12):1129-33.
44. Barbosa Neto O, da Mota GR, De Sordi CC, Resende EAMR, Resende LAPR, Vieira da Silva MA, et al. Long-term anabolic steroids in male bodybuilders induce cardiovascular structural and autonomic abnormalities. Clin Auton Res. 2018;28(2):231-44.
45. Díaz Conde M, Brito Miranda D, Márquez Villegas FG, Hernández Pliego RR. Paro cardiaco repentino atribuido a miocardiopatía hipertrófica por uso de esteroides anabólicos. Reporte de caso. Medicina crítica (Colegio Mexicano de Medicina Crítica). 2017;31(2):101-5.
46. Pereira-Junior PP, Chaves EA, Costa-e-Sousa RH, Masuda MO, de Carvalho ACC, Nascimento JH. Cardiac autonomic dysfunction in rats chronically treated with anabolic steroid. European journal of applied physiology. 2006;96(5):487-94.
47. de Souza FR, Sales ARK, Dos Santos MR, Porello RA, Fonseca GWP da, Sayegh ALC, et al. Retrograde and oscillatory shear rate in young anabolic androgenic steroid users. Scand J Med Sci Sports. marzo de 2019;29(3):422-9.
48. Maior AS, Carvalho AR, Marques-Neto SR, Menezes P, Soares PP, Nascimento JHM. Cardiac autonomic dysfunction in anabolic steroid users. Scand J Med Sci Sports. octubre de 2013;23(5):548-55.
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