Metabolic & Cardiometabolic
anabolic-androgenic steroids increases cardiovascular disease risk
In plain terms: Do anabolic steroids increase cardiovascular disease risk?
Strong support Metabolic & Cardiometabolic 🔬 Includes disconfirming
Part of: 💊 anabolic-androgenic steroids
RefutedContestedStrong support
consensus score 0.80
Yes — a nationwide cohort and imaging studies show steroid users have more coronary plaque, worse heart function and adverse lipids; long-term cardiovascular risk is clearly raised (short courses may not show acute changes).
📅 Last reviewed: 2026-07-14 ⓘ
Evidence ladder
How far up the ladder this claim has climbed. A high consensus on a low rung means "consistent so far," not "proven in people."
Top evidence so far: ()
MechanismIn-vitroAnimalObservationalRCTMeta-analysis
How the studies fall
19 support 0 contradict 1 tested null 3 mixed · 23 sources, 19 independent groups
What the evidence shows
Anabolic-androgenic steroid users show markedly more coronary plaque, reduced left-ventricular function and greater left-ventricular mass than weightlifting non-users, with myocardial fibrosis reproduced in animals. The human evidence is observational, and short courses of up to sixteen weeks change nothing detectable, so the harm tracks long-term use.
The evidence (30)
| Source | Grade | Stance | Quality | Finding |
|---|---|---|---|---|
| de Souza FR, Dos Santos MR, Rochitte CE, Dos Santos RP, Jordão CP, Leite IS, da Fonseca GWP, Fonseca RA, de Oliveira TF, Yonamine M, Pereira RMR, Negrão CE, Alves NNMJ 2022 · Int J Sports Med | observational | supports | moderate | Strength-trained AAS users showed impaired myocardial contractility (reduced strain) and higher LV mass by cardiac MRI versus non-users. |
| Vasilaki F, Tsitsimpikou C, Tsarouhas K, Germanakis I, Tzardi M, Kavvalakis M, Ozcagli E, Kouretas D, Tsatsakis AM 2016 · Toxicol Lett | animal | supports | moderate | Long-term nandrolone in rabbits caused focal myocardial fibrosis, oxidative stress and diastolic impairment. |
| Di Fazio N, Volonnino G, Treglia M, Delogu G, Bubbico T, Rinaldi R, La Russa R, Maiese A 2025 · Front Cardiovasc Med | observational | supports | low | Systematic review of AAS-related deaths found LV hypertrophy, myocardial fibrosis and sudden cardiac death even without coronary disease. |
| Fyksen TS, Gravning J, Rossebø A, Vanberg P, Grøtta OJ, Atar D, Halvorsen S 2025 · Open heart | observational | supports | moderate | Prospective cohort of 32 AAS users vs 13 strength-trained non-users followed a median of 16 vs 13 years: users had larger LV mass (266g vs 215g, p<0.01) and lower LVEF (49% vs 53%, p=0.05) at baseline; LVEF remained impaired in continued us |
| Ahmed AE, Sahli AH, Alenezi ML, Jamor OA, Alsubaie MA 2026 · Cureus | n-of-1 | supports | low | Single case report: 29-year-old man with long-term AAS abuse developed cerebral venous sinus thrombosis with polycythemia; thrombophilia workup unremarkable, improved with anticoagulation and steroid cessation. |
| Hartgens F, Cheriex EC, Kuipers H 2003 · Int J Sports Med | RCT | tested-null | high | Short-term (up to 16 weeks) AAS/nandrolone administration produced no detectable echocardiographic changes in heart structure or function. |
| Baggish AL, Weiner RB, Kanayama G, Hudson JI, Lu MT, Hoffmann U, Pope HG 2017 · Circulation | observational | supports | high | AAS users had reduced LV systolic/diastolic function and markedly higher coronary atherosclerotic plaque volume than non-using weightlifters. |
| Vecchiato M, Palermi S, Zamodics M, Babity M, Eftekhari M, Ryali R, Luk J, Taseh A, Ashkani-Esfahani S, Merkely G, Juhasz V 2026 · Sports medicine - open | observational | supports | moderate | Review of performance-enhancing drug classes noting AAS (with ESAs) show the strongest ergogenic signals but are also associated with myocardial remodeling, arrhythmia, and thrombotic events; states current PED-CV evidence derives mainly fr |
| Celik H, Tuysuz MZ, Aktas Y, Eren MA, Demirbag R 2024 · Medicina | observational | mixed | low | Bodybuilders showed altered paraoxonase/arylesterase activity and lipid profiles associated with a pro-atherosclerotic pattern. |
| Abdelsamie AH, Abdelhadi HO 2025 · JACC. Case reports | observational | supports | low | Single case report: 30-year-old male with AAS abuse history presented with NSTEMI; OCT-confirmed intimal hyperplasia, plaque erosion, and thrombus in the LAD, attributed by authors to AAS-related atherogenic/thrombogenic/vasospastic mechani |
| Iliakis P, Stamou E, Kasiakogias A, Manta E, Sakalidis A, Vakka A, Theofilis P, Kourti FE, Konstantinidis D, Dimitriadis K, Vlachopoulos C, Tsioufis C 2025 · Biomedicines | observational | supports | moderate | Narrative review summarizing pathophysiological mechanisms (oxidative stress, androgen receptor overactivation, RAAS dysregulation) by which chronic supraphysiologic AAS use causes hypertension, dyslipidemia, atherosclerosis, myocardial fib |
| D'Andrea A, Radmilovic J, Russo V, Sperlongano S, Carbone A, Di Maio M, Ilardi F, Riegler L, D'Alto M, Giallauria F, Bossone E, Picano E 2022 · Eur J Prev Cardiol | observational | supports | moderate | AAS-abusing athletes showed biventricular dysfunction and lung congestion on speckle-tracking and stress echocardiography. |
| de Carvalho Vilarinho M, Cernadas J, Marques Ferreira M 2025 · Cureus | observational | supports | low | Case report: 30-year-old male with chronic AAS abuse found to have dyslipidemia and hypertension attributed to AAS use, alongside gynecomastia and testicular atrophy. |
| Vanberg P, Atar D 2010 · Handb Exp Pharmacol | observational | supports | moderate | Review concludes AAS raise LDL and lower HDL, induce a prothrombotic state and hypertrophy, increasing cardiovascular disease risk. |
| Place F, Hamilton C, Carpenter H, Howard LJ, Morrison BN, Chester N, Cooper R, Stansfield BN, George KP, Angell P, Oxborough D 2026 · Echocardiography (Mount Kisco, N.Y.) | observational | supports | moderate | Cross-sectional study of 141 resistance-trained individuals: current AAS users (n=95) had higher calibrated integrated backscatter than non-users (n=46) (-19.54±4.63 vs -20.88±3.94, p=0.047), correlating with LV mass index and LA stiffness |
| Poyorena C, Allen C, Querin LB 2025 · Cureus | n-of-1 | supports | low | Single case report: 45-year-old with anabolic steroid and pre-workout use presented with hyperacute T waves progressing to ventricular fibrillation and cardiac arrest, meeting STEMI criteria after ROSC. |
| Ilić I, Djordjević V, Stanković I, Vlahović-Stipac A, Putniković B, Babić R, Nesković AN 2014 · Hellenic J Cardiol | observational | supports | moderate | AAS-using athletes showed adverse LV remodeling and diastolic function changes versus non-using athletes. |
| Davies A 2026 · Cureus | n-of-1 | supports | low | Single case report: AAS-using patient presented with pulmonary oedema from suspected steroid-induced cardiomyopathy, confirmed by MRI showing hypertrophied LV with systolic dysfunction. |
| Windfeld-Mathiasen J, Heerfordt IM, Dalhoff KP, Andersen JT, Andersen MA, Johansson KS, Biering-Sørensen T, Olsen FJ, Horwitz H 2025 · Circulation | observational | supports | high | Nationwide cohort of male AAS users showed substantially higher incidence of cardiovascular disease than age/sex-matched general-population controls. |
| Gurumurthy G, Thachil J 2025 · Research and practice in thrombosis and haemostasis | observational | supports | low | Review describing AAS use as predisposing to venous and arterial thromboses via androgen-induced polycythemia, platelet hyperaggregability, procoagulant shifts, and vascular injury; notes current evidence is largely observational/pharmacolo |
| Magnolini R, Bottoni SL, Hammer H, Capraro J, Bruggmann P, Senn O 2025 · Harm Reduction Journal | n-of-1 | supports | low | Case report of a 38-year-old bodybuilder after about 8 years of non-medical androgen use with growth hormone and insulin: blood pressure 160/81 mmHg, haematocrit 56.9% (reference 43-49%), splenomegaly, and left ventricular hypertrophy (septum 14 mm, LVEF 65%, strain GLS -15%) diagnosed as anabolic steroid-induced cardiomyopathy. Cardiac structure and function normalised 4 months after cessation, though an ACE inhibitor began at the same time. He died at 19 months of a probable pulmonary embolism; no autopsy was done, and an undisclosed HIV infection and testosterone replacement emerged only afterwards. |
| Udd-Garnica K, Morad T, Webb M, Hsu JJ 2026 · JACC. Case reports | n-of-1 | supports | low | Single case report: 34-year-old on testosterone developed nonischemic cardiomyopathy with LVEF 16% and global LV hypokinesis/dilation; discussion cites AAS users having significantly higher incidence of MI, coronary intervention, VTE, arrhy |
| Barbosa Neto O, da Mota GR, De Sordi CC, Resende EAMR, Resende LAPR, Vieira da Silva MA, Marocolo M, Côrtes RS, de Oliveira LF, Dias da Silva VJ 2018 · Clin Auton Res | observational | supports | moderate | Male bodybuilder AAS users had higher blood pressure, altered cardiac dimensions and cardiac autonomic dysfunction. |
| Buhl LF, Christensen LL, Hjortebjerg R, Hasific S, Hjerrild C, Harders S, Lillevang-Johansen M, Glintborg D, Andersen MS, Thevis M, Kistorp C, Rasmussen JJ, Lindholt JS, Diederichsen ACP, Frystyk J 2025 · JAMA network open | observational | supports | high | Cross-sectional study of 164 Danish recreational athletes (80 active AAS users, 26 former users, 58 non-users): longer cumulative AAS use was associated with higher odds of positive coronary artery calcium score (OR 1.23, 95% CI 1.09-1.39) |
| Borowiec A, Waluszewska I, Jurkiewicz M, Szczurek-Wasilewicz W 2025 · International journal of molecular sciences | observational | supports | low | Narrative review (not a formal SR/MA) synthesizing mechanistic and clinical literature on AAS-induced endothelial injury, oxidative stress, fibrosis, and arrhythmogenesis, describing AAS abuse as a modifiable cardiovascular risk factor. |
| Vauhkonen PK, Kiiskilä JM, Hytönen S, Koskela R, Mäyränpää MI, Lindroos KM 2026 · International journal of legal medicine | observational | mixed | low | Forensic autopsy comparative study of 16 AAS-positive vs 30 AAS-negative male decedents: overall arteriolosclerosis, hypertrophy, disarray, and fibrosis frequencies were similar between groups, though AAS-positive cases showed more diffuse/ |
| Buhl LF, Christensen LL, Bulut Y, Hasific S, Harders S, Glintborg D, Andersen MS, Thevis M, Kistorp C, Rasmussen JJ, Lindholt JS, Diederichsen A, Frystyk J, Hjortebjerg R 2026 · European journal of endocrinology | observational | supports | moderate | Cross-sectional study of 80 active AAS users, 26 former users, and 58 non-users found active users had altered IGF-2/IGFBP-3/STC2 levels; higher STC2 associated with adverse cardiac outcomes and lower IGF-2/IGFBP-3 with lower LV mass and be |
| Makarem NN, El Jammal M 2025 · Cureus | n-of-1 | supports | low | Single case report: 35-year-old bodybuilder on trenbolone/testosterone/nandrolone for six weeks suffered acute MI with 80% coronary lesion. |
| Urhausen A, Albers T, Kindermann W 2004 · J Sports Med Phys Fitness | observational | mixed | moderate | Some adverse cardiac effects (hypertrophy, diastolic changes) persisted while others partly reversed after AAS cessation in strength athletes. |
| Meagher S, Irwig MS, Rao P 2025 · Curr Opin Cardiol | mechanism | supports | moderate | Narrative review, no new data: 'Herein, we present an updated review on AAS in recreational athletes and their cardiovascular risk.' Its numbers are other papers' estimates, e.g. 'a meta-analysis found AAS use was associated with an increase in systolic BP of 12.43 mmHg and diastolic BP by 8.09 mmHg.' Review — zero weight. |
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