Duration-Dependent Cardiac Effects of Anabolic-Androgenic Steroid Use in Strength-Trained Athletes: A Systematic Review and Meta-Analysis.

Authors

Matheus de Medeiros Fernandes, Pedro Gomes Batista, Camila Viviane Ribera Chagas, Railla Raquel Albino Dos Santos Silva, Fernanda Medeiros Santos, Miguel Chaves Lenzi, Felipe de Medeiros Fernandes, Ranna Santos Pessoa, Patrícia Jovelina de Freitas, Flávio Henrique Amaral Pires Véras, Stephan Barisic Junior, Douglas Nunes Cavalcante, Juliana Giorgi, Caroline Fischer-Bacca

Published in

Echocardiography (Mount Kisco, N.Y.). Volume 43. Issue 9. Pages e70611.

Abstract

Nonmedical anabolic-androgenic steroid (AAS) use is increasing, and its duration-dependent cardiac effects remain unclear. We evaluated cardiac structure and function in AAS-using strength-trained athletes, overall and by exposure duration.
We searched PubMed, Embase, Cochrane Central, and SCOPUS through November 2025 for observational studies comparing AAS-using and nonusing strength-trained athletes of either sex. Random-effects models pooled mean differences (MD) overall and across four exposure strata (<6 months, 6 months-3 years, 3-6 years, >6 years); meta-regression assessed duration as a continuous moderator.
Forty studies (1906 athletes; 95% male) were included. Overall, AAS users showed reduced left ventricular ejection fraction (LVEF; 29 studies; MD -2.84%; 95% CI -4.24 to -1.44; p < 0.01), impaired global longitudinal strain (GLS; MD +3.27%; p < 0.01), and increased left ventricular mass index (LVMI; MD +18.21 g/m²; p < 0.01). Septal thickening was detectable before six months, preceding functional impairment. LVEF, LVMI, and posterior wall thickness (PWT) differed significantly across strata (all p ≤ 0.03), with the largest LVEF reduction beyond six years (MD -7.39%; 95% CI -10.71 to -4.07). Meta-regression suggested that exposure duration was associated with variation in selected structural and functional outcomes, corroborating LVEF, LVMI, and PWT, while GLS, E/e', and E/A ratio showed no significant association. Right ventricular strain was impaired in an exploratory, non-stratified analysis.
AAS use is associated with cardiac structural and functional abnormalities, with exposure duration associated with selected, but not all, outcomes. These cross-sectional comparisons do not establish within-person progression; longitudinal surveillance with deformation imaging is warranted.

PMID:
42672095
Bibliographic data and abstract were imported from PubMed on 01 Sep 2026.

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