To reiterate, our current understanding of the adverse cardiovascular effects of anabolic steroids is based on rather limited information gathered from a small number of research studies. The available reports, though, certainly give a glimpse of unwanted cardiovascular effects that may occur, even if the causal mechanisms are not yet understood. Going forward, we are unlikely to have large-scale prospective studies to gather more information and additional retrospective studies are likely to have the methodologic pitfalls I mentioned above. Given our current understanding, athletes who choose to use anabolic steroids should be aware of the possibilities of high blood pressure, unfavorable lipid profile, structural changes in the heart, and even heart attack or SCD.
As an aside, I’ll throw this thought out there and see if anyone else feels the same. My whole life (35 years) all I’ve ever heard is that steroids are Very Bad Drugs taken by Bad Cheaters and that you’ll lose your mind and go pillage and plunder the neighboring towns because of your roid rage. None of it was true. Not then, not now. Meanwhile, doctors are handing out a fun class of drugs called ‘atypical antipsychotics’ to people with garden variety depression . Drugs made for people with serious mental illnesses have made their way into the normal prescribing habits of doctors all across America, and yet I hear not a peep about it in the zeitgeist. Go ask a 19 year old kid who’s never lifted a weight in his life what he thinks steroids do. After he washes down his Zyprexa with a Red Bull and finishes his bong rip, he’ll tell you that steroids give you roid rage and shrink your d*ck.
Of course, the acute issues (thicker blood, poorer lipids, platelet aggregation) feed into this further, hence the annoying circular complexity of it all, and thus presumably the reason so few give a shit about it. But if you control the inotropic/chronotropic (BP and heart rate) effect by limiting both CNS stimulation and arterial stiffening - cut out stimulants, reduce use of highly androgenic AAS, do regular cardio, or alternatively supplement with appropriate pharmaceutical blockers - the acute effects become much less likely to be in a position to cause harm.