Atherogenic effects of anabolic steroids on serum lipid levels. A literature review.This article reviews effech current body of literature linking anabolic steroids to atherogenic alterations in serum lipid levels. The mechanism of these lipid changes, their time course in relation to anabolic steroid use, and their dependency on route of anabolic steroid administration are discussed. Interpretation of the observed lipid level changes in light of the epidemiologic data linking lipids to coronary heart disease risk is used to estimate the lipid-based increase in coronary fefect disease risk due to anabolic steroid use. Sign egfect to access your subscriptions Sign in to your personal account. Create a free personal account to download effect of anabolic steroids on lipids article PDFs, sign up for dianabol omega lab opiniones, and more. Purchase access Subscribe to the journal. Create a free personal account to access your subscriptions, sign up for alerts, and more.
To investigate the effects of two different regimens of androgenic-anabolic steroid AAS administration on serum lipid and lipoproteins, and recovery of these variables after drug cessation, as indicators of the risk for cardiovascular disease in healthy male strength athletes.
In a non-blinded study study 1 serum lipoproteins and lipids were assessed in 19 subjects who self administered AASs for eight or 14 weeks, and in 16 non-using volunteers. Total cholesterol and triglycerides did not change significantly.
Alterations after eight and 14 weeks of AAS administration were comparable. No changes occurred in the controls. Administration of AAS for 14 weeks was associated with slower recovery to pretreatment concentrations than administration for eight weeks.
Six weeks after the intervention period, Lp a concentrations had returned to baseline values in both groups. Self administration of several AASs simultaneously for eight or 14 weeks produces comparable profound unfavourable effects on lipids and lipoproteins, leading to an increased atherogenic lipid profile, despite a beneficial effect on Lp a concentration.
The changes persist after AAS withdrawal, and normalisation depends on the duration of the drug abuse. Eight weeks of administration of nandrolone decanoate does not affect lipid and lipoprotein concentrations, although it may selectively reduce Lp a concentrations. The effect of this on atherogenesis remains to be established. The misuse of androgenic-anabolic steroids AASs in young, healthy strength athletes has been associated with the occurrence of premature cardiovascular events.
Most athletes take AASs for periods of 8—12 weeks several times a year. Various studies have suggested that the concentration of lipoprotein a Lp a is an independent risk indicator for the development of vascular disease. A close correlation has been reported between the serum concentration of Lp a and the accumulation of this particle in the vascular wall.
The aim of the present studies was to investigate the effects of AASs on lipoproteins and lipids in healthy, young strength athletes. To obtain more insight into the relation between dose of AAS and the response on plasma lipid variables, we performed two prospective studies: The first investigated the effects of self administration of high doses of AASs on these variables.
In the second study, the effects of a commonly used single AAS, nandrolone decanoate, on lipoprotein risk factors and Lp a were examined. In both studies we also assessed the recovery of the lipoprotein and lipid variables after cessation of drug administration. This study was part of a larger one exploring the effects of AASs on body composition, exercise performance, and health status in male strength athletes. About 90 strength athletes volunteered to participate in one or more of these studies after they had been given detailed informed.
All volunteers completed an extensive questionnaire with questions on health status, history, training habits, and the use of AASs, and had a full physical examination to exclude any relevant diseases. The following exclusion criteria were set: The study was approved by the medical ethical review committee of Maastricht University and the University Hospital Maastricht, and all subjects gave their written informed consent before participating.
This was a prospective, non-blinded investigation of the effects of AAS self administration. Thirty five male strength athletes participated. Nine used AASs for eight weeks, and the remaining 10 for on average 14 weeks range 12— Table 1 presents the physical and training characteristics of the two groups.
Baseline characteristics of the participants of the androgenic-anabolic steroid AAS self administration study study 1. On average, they had started AAS use 4. The mean number of cycles used was 7. The participants were expected to have been drug free for at least three months before the start of the study.
From information supplied by the subjects, the AAS users had been drug free for 8. However, to objectively exclude recent drug use, urine was collected from all subjects for drug analysis. The subjects in the AAS group purchased the AASs on the black market, although some subjects had received a prescription from a doctor. They designed their AAS courses on the basis of their own experience and beliefs. They administered several steroids oral and intramuscular simultaneously.
The total amount administered by each participant during the study by far exceeded the recommended therapeutic dose. Table 2 presents a detailed description of the AASs used by each subject.
The investigators were not involved in purchasing and administering these compounds nor did they recommend doses. Total amount of androgenic-anabolic steroids AASs and other drugs used by each subject. At baseline, and after 8 and after 14, depending on the duration of use weeks of AAS use, and six weeks after cessation, blood was drawn from the antecubital vein after a 10 hour fast, for the measurement of serum lipids and lipoproteins.
This was a randomised, double blind, placebo controlled clinical trial. Sixteen well trained recreational bodybuilders volunteered to participate. None had previously used AASs.
Table 3 presents their physical and training data. Baseline characteristics of the participants of the double blind, randomised, placebo controlled study study 2. At baseline, after the four and eight week intervention periods, and six weeks after cessation, blood was drawn after a 10 hour fast for the measurement of serum lipids and lipoproteins.
In both studies, all subjects maintained their regular training and nutritional regimens, and both kept diaries which were monitored. In study 1, before the start of the study and in week 8, all subjects of both groups recorded their training workouts and hours in a seven day training diary and their nutritional habits with the aid of a three day nutritional diary. The AAS users also made similar records in week 6 after drug withdrawal. Volunteers who self administered AASs for 14 weeks also recorded training and nutritional data in the last week of AAS use.
In study 2, training and nutritional data were collected at baseline, after the four and eight week intervention period, and six weeks after the administration of nandrolone decanoate or placebo had been stopped. Weekly training hours were assessed from the training data. The intake of protein, fat saturated and unsaturated , carbohydrates, cholesterol, linoleic acid, vitamins, and trace elements was calculated from the nutritional diaries using the computer program Becel version NL04a; Unilever, Rotterdam, the Netherlands.
To objectively monitor compliance in all subjects, urine samples were collected for drug analysis several times.
In study 1, urine samples were collected from all volunteers at baseline and after the eight week study period. In addition, samples were collected from the AAS users six weeks after AAS withdrawal, and from the long term users after 14 weeks. In the double blind study, urine samples were collected at baseline, after four and eight weeks, and six weeks after the end of the intervention period. Overall, urine samples were collected, 99 in study 1 and 64 in study 2. This resulted in 34 samples from study 1 being analysed and 25 from study 2.
HDL-C was measured enzymatically after precipitation of low density and very low density lipoproteins with poly ethylene glycol The within and between assay coefficients of variation were 1. Serum apolipoprotein a concentration was measured by a solid phase, two site immunoradiometric assay using two monoclonal antibodies to different epitopes of apolipoprotein a Pharmacia Diagnostics, Uppsala, Sweden.
Data are expressed as mean SD unless otherwise reported. Results were analysed on the StatView version 4. Group differences in baseline variables were compared by the Mann-Whitney U test. The same test was applied to compare changes in lipid variables between the treatment groups. Intragroup comparison of lipid variables after drug cessation with baseline data were performed with the Wilcoxon signed rank test, because data from non-using controls were only available for eight weeks.
Table 1 gives the physical and training characteristics of the 35 participants of the self administration study. At baseline, the AAS and CO group were comparable with respect to age, height, weight, training experience, and weekly training hours.
Nutritional intake of AAS users and controls was comparable. No significant differences in lipid and lipoprotein variables between the two groups were observed. During the study all subjects maintained their regular training regimens. No change in weekly training hours was observed in any subject.
The same was true for nutritional intake. Sequence of changes in serum lipids and lipoproteins induced by eight weeks of anabolic-androgenic steroid self administration and recovery after drug cessation study 1.
After AAS self administration was stopped, the lipoprotein variables only slowly returned to normal; six weeks after AAS withdrawal they had not returned to baseline concentrations. Recovery was significantly slower after 14 weeks of AAS use than after eight weeks.
In particular, Lp a concentrations remained decreased in the long term users, whereas in the short term users there was a complete return to baseline values six weeks after drug withdrawal table 5. Influence of duration of anabolic-androgenic steroid self administration on lipoprotein variables and on recovery after cessation of use. At baseline, all urine samples analysed were free of AASs and metabolites. After the eight week study period, urinanalysis of the CO group was negative.
As expected, the urine samples of the AAS group contained a large variety of metabolites of androgenic-anabolic substances after eight and when applicable after 14 weeks.
At the start, the physical characteristics, training data, and nutritional habits of the two groups were comparable. Table 6 presents the baseline serum lipoprotein and lipid concentrations of the 16 participants in the double blind nandrolone study.
There were no significant differences between the two groups at the start. Sequence of serum concentrations of lipids and lipoproteins of the bodybuilders in the randomised, double blind, placebo controlled study study 2. Also, no significant changes in Apo-A1 and Apo-B were observed. In the placebo treated subjects, a significant reduction in Lp a concentration was also observed.
However, the changes in Lp a were not significantly different between the two groups. During the study period, training work load and nutritional intake did not change significantly between the two groups. Urinanalysis showed no AASs or metabolites at baseline. After four and eight weeks, the same was true for the placebo group whereas urinalysis of the nandrolone group showed only metabolites of nandrolone decanoate. Six weeks after the intervention period in some subjects who had received verum, small amounts of metabolites of nandrolone decanoate were still present.
This leads to an increased risk of cardiovascular disease. The serum concentration of the atherogenic Lp a particle was also lowered. Eight weeks of nandrolone decanoate at a high therapeutic dose, however, produced no detrimental effects on serum concentrations of Apo-A1 and Apo-B, triglycerides, total cholesterol, and HDL-C and subfractions.