Echocardiography shows the adverse effects of anabolic steroid use among athletes, according to research published August 29 in JAMA Network Open.
A team led by Jan Frystyk, MD, PhD, from Odense University Hospital in Denmark found that both male and female athletes who use steroids have a higher lifetime risk of coronary atherosclerosis and myocardial dysfunction.
“And athletes with anabolic androgenic steroid exposure exceeding five years showed more severe calcification,” the Frystyk team wrote.
The use of anabolic androgenic steroids is common among recreational athletes. However, the researchers noted a lack of data tying steroid use to adverse cardiovascular outcomes, especially in women.
Frystyk and colleagues used echocardiography to assess cardiovascular health in recreational athletes who use anabolic androgenic steroids. They compared results with those of athletes who do not use steroids.
The cross-sectional, single-center study included 164 participants. Of these, 80 were active steroid users (median age, 35). The steroid group included 61 men and 19 women. Of the total participants, 26 were previous steroid users and 58 did not use steroids. Median cumulative lifetime steroid use was 2.2 years for active users and 2.2 years for previous users.
While the authors did not specify which sports the athletes played, they noted that the athletes played at the recreational level.
The researchers observed no group differences when comparing the number of participants with femoral or carotid artery plaques or coronary artery calcium (CAC) scores. However, they did find a statistically significant difference in the prevalence of coronary noncalcified plaques (NCPs) between active users (n = 19, 23.8%) and nonusers (n = 6, 10.3%; p = 0.03).
The investigators also reported that athletes who used steroids had greater odds of having a positive CAC score (odds ratio [OR], 1.23; p = 0.001) and coronary NCPs (OR, 1.17; p = 0.004) and that those who used steroids for more than five years had a greater severity of calcifications (n = 94; chi-squared = 9.78; p = 0.04).
Echocardiograms showed significant links between cumulative steroid use and worse left ventricular (regression coefficient: 0.08; p = 0.002) and right ventricular (0.08; p = 0.001) global longitudinal strain.
Finally, almost all athletes (35 of 36) with more than five years of cumulative steroid use had ventricular mass greater than and left ventricular ejection fraction below the median of the normal range.
The study findings support measures to prevent anabolic androgenic steroid use by both men and women in recreational sports, the authors concluded.
Read the full study here.
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
