Chronic anabolic androgenic steroid administration reduces global longitudinal strain among off-cycle bodybuilders

Sabah Hammoud, Bart J. F. van den Bemt, Ayman Jaber, Mazen Kurdi*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Background: Supra-physiologic doses of anabolic androgenic steroids (AAS) lead to multiple cardiovascular complications. The long-term clinical effect of AAS overuse on cardiac structure and function, which persists during off-cycle periods, remains unclear. Methods: A total of 15 sedentary subjects and 79 bodybuilders (26 AAS non-users and 53 AAS-users), matched for age and male gender, were assessed in a cross-sectional design for echocardiography measures. AAS-users were included during an off-cycle phase, abstained from AAS for at least 1 month. 2D standard M-mode and speckle tracking echocardiography were used to measure cardiac dimensions and functions. Results: Inter-ventricular septum and posterior wall thickness were significantly higher among chronic off-cycle AAS-users compared to AAS non-users and sedentary group. Off-cycle AAS-users showed lower E/A ratio of the diastolic function. Left ventricular systolic function was not affected in terms of ejection fraction, but significant subclinical systolic dysfunction, assessed by GLS, was observed for chronic off-cycle AAS-users compared to AAS non-users (GLS = -16.8% vs. -18.5%, respectively; p = 0.001). Diameter of left atrium and right ventricle were significantly enlarged among off-cycle AAS-user bodybuilders (p = 0.002 and 0.040). TAPSE and RV S′, and cardiac vasculature of aorta were comparable in all groups. Conclusions: This study demonstrates that during off-cycle phase, AAS-users show long-term impaired GLS, even after considerable AAS abstain, despite normal LVEF. It highlights the importance of following GLS to predict hypertrophy and heart failure events, and not relying on LVEF alone. In addition, the hypertrophic effect of chronic AAS consumption is transitional during AAS washout periods.

Original languageEnglish
Pages (from-to)153-160
Number of pages8
JournalInternational Journal of Cardiology
Issue number1
Publication statusPublished - 15 Jun 2023


  • Anabolic androgenic steroid
  • Bodybuilder
  • Echocardiography
  • Strain imaging
  • Systolic dysfunction


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