Clinical Scorecard: Anabolic-Androgenic Steroid Use and Myocardial Flow Reserve in Women
At a Glance
Category
Detail
Condition
Coronary microvascular function assessed by myocardial flow reserve (MFR) in women with current or former anabolic-androgenic steroid (AAS) use
Key Mechanisms
MFR is the ratio of adenosine-stressed to resting myocardial blood flow. The authors discuss possible explanations for lower resting myocardial blood flow among current users, including androgen-associated erythrocytosis, training-related autonomic adaptation, and mismatch between myocyte hypertrophy and microvascular angiogenesis.
Target Population
Women who regularly resistance train, have no history of cardiovascular disease, and are current or former AAS users, compared with women who have never used AAS
Care Setting
Cross-sectional research evaluation using resting and adenosine-stressed cardiac 82Rb PET/CT; the study does not specify a clinical care setting
Key Highlights
The cohort included 54 women: 20 current AAS users, 17 former users, and 17 controls who had never used AAS.
Mean MFR and the frequency of clinically or subclinically impaired MFR did not differ between AAS users and controls.
Among former users, longer cumulative AAS exposure was associated with lower MFR, including after adjustment for age and time since cessation; the cross-sectional finding does not establish causation.
Resting myocardial blood flow was lower in current users than in controls.
The cross-sectional design and small sample size limit causal inference.
Guideline-Based Recommendations
Diagnosis
The study assessed MFR using resting and adenosine-stressed cardiac 82Rb PET/CT, calculated as stressed-to-resting myocardial blood flow.
The study defined MFR below 2.0 as clinically impaired and below 2.5 as subclinically impaired.
Management
Monitoring & Follow-up
Risks
The article cites MFR as an independent predictor of adverse cardiovascular events and mortality.
The authors note that reduced resting myocardial blood flow can arithmetically increase MFR and may conceal microvascular impairment among current AAS users.
Among former users, longer AAS exposure was associated with lower MFR; the cross-sectional design cannot establish causation.
Patient & Prescribing Data
Women who regularly resistance train and have no cardiovascular disease history; AAS users were required to have at least 4 weeks of exposure, and former users had stopped at least 3 months before enrollment.
This was an observational study, not a treatment trial. Oxandrolone was the preferred AAS; prior use was reported by 90% of current users and 94% of former users.
Clinical Best Practices
The authors identify the small sample and cross-sectional design as limitations, including inability to infer causation.
The study reported an association between cumulative AAS exposure and lower MFR among former users.
The authors note that lower resting myocardial blood flow can arithmetically increase MFR.
