Abstract Body (Do not enter title and authors here): Introduction: Anabolic-androgenic steroids (AAS) have been used for performance enhancement by athletes, exposing them to potential cardiovascular effects and structural changes. Some athletes also present cardiac structural or functional changes secondary to resistance training. Therefore, the true effect of AAS in echocardiographic parameters among athletes remains unclear.
Research question: What are the changes in echocardiographic parameters in athletes who use AAS compared with those who do not use AAS.
Objective: We aimed to perform a systematic review and meta-analysis comparing use with no use of AAS in athletes for echocardiography parameters.
Methods: PubMed, Embase, and Cochrane were systematically searched for studies that assessed echocardiographic changes in athletes who used AAS compared to non-users. We computed mean differences (MD) for all continuous outcomes, with 95% confidence intervals (CI) pooled under a random-effects model. Heterogeneity was assessed with I² statistics. Statistical analysis was performed using Review Manager (Cochrane Collaboration).
Results: We included 13 studies with 742 male athletes (401 AAS vs 341 control; mean age 33.4 and 32.4 years respectively). AAS was associated with a decrease left ventricular (LV) ejection fraction (MD -3.17%; 95% CI -5.51, -0.83%; p=0.008; Figure 1A) and global longitudinal strain (MD 3.58%; 95% CI 2.95, 4.20%; p<0.001; Figure 1B) when compared to no use. Athletes who used AAS also had an increased septal wall thickness (MD 0.98 mm; 95% CI 0.06, 1.9 mm; p=0.04; Figure 2A.), posterior wall thickness (MD 1.16 mm; 95% CI 0.57, 1.75 mm; p<0.01; Figure 2B) and LV mass (MD 42.9g; 95% CI 23.2, 62.5g; p<0.0001; Figure 2C) when compared to non-user athletes. LV end-diastolic diameter (MD 1.26mm; 95% CI 0.00, 2.51mm; p=0.05; Figure 2D) showed a tendency to increase in AAS users, but with no significant difference.
Conclusion: AAS use among athletes is associated with reduced LV function and increased LV hypertrophy and overload, compared with athletes who do not use AAS.