{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T22:30:59Z","timestamp":1792103459947,"version":"4.4.0"},"reference-count":38,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2023,11,22]],"date-time":"2023-11-22T00:00:00Z","timestamp":1700611200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100006095","name":"South-Eastern Norway Regional Health Authority","doi-asserted-by":"publisher","award":["2016049, 2017025, 2018075"],"award-info":[{"award-number":["2016049, 2017025, 2018075"]}],"id":[{"id":"10.13039\/501100006095","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100006095","name":"South-Eastern Norway Regional Health Authority","doi-asserted-by":"publisher","award":["2020088"],"award-info":[{"award-number":["2020088"]}],"id":[{"id":"10.13039\/501100006095","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100005416","name":"Norwegian Research Council","doi-asserted-by":"publisher","award":["#309762"],"award-info":[{"award-number":["#309762"]}],"id":[{"id":"10.13039\/501100005416","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Precision Health Center"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,3,27]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>This study aims to explore the cardiovascular effects of long-term anabolic\u2013androgenic steroid (AAS) use in both current and former weightlifting AAS users and estimate the occurrence of severe reduced myocardial function and the impact of duration and amount of AAS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>In this cross-sectional study, 101 weightlifting AAS users with at least 1 year cumulative AAS use (mean 11 \u00b1 7 accumulated years of AAS use) were compared with 71 non-using weightlifting controls (WLC) using clinical data and echocardiography. Sixty-nine were current, 30 former (&amp;gt;1 year since quitted), and 2 AAS users were not available for this classification. Anabolic\u2013androgenic users had higher left ventricular mass index (LVMI) (106 \u00b1 26 vs. 80 \u00b1 15\u2005g\/m2, P &amp;lt; 0.001), worse left ventricular ejection fraction (LVEF) (49 \u00b17 vs. 59 \u00b1 5%, P &amp;lt; 0.001) and right ventricular global longitudinal strain (\u221217.3 \u00b1 3.5 vs. \u221222.8 \u00b1 2.0%, P &amp;lt; 0.001), and higher systolic blood pressure (141 \u00b1 17 vs. 133 \u00b1 11\u2005mmHg, P &amp;lt; 0.001) compared with WLC. In current users, accumulated duration of AAS use was 12 \u00b1 7 years and in former 9 \u00b1 6 years (quitted 6 \u00b1 6 years earlier). Compared with WLC, LVMI and LVEF were pathological in current and former users (P &amp;lt; 0.05) with equal distribution of severely reduced myocardial function (LVEF \u226440%) (11 vs. 10%, not significant (NS)). In current users, estimated lifetime AAS dose correlated with reduced LVEF and LVGLS, P &amp;lt; 0.05, but not with LVMI, P = 0.12. Regression analyses of the total population showed that the strongest determinant of reduced LVEF was not coexisting strength training or hypertension but history of AAS use (\u03b2 \u22120.53, P &amp;lt; 0.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Long-term AAS users showed severely biventricular cardiomyopathy. The reduced systolic function was also found upon discontinued use.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/eurjpc\/zwad362","type":"journal-article","created":{"date-parts":[[2023,11,21]],"date-time":"2023-11-21T18:05:31Z","timestamp":1700589931000},"page":"599-608","source":"Crossref","is-referenced-by-count":51,"title":["Severe biventricular cardiomyopathy in both current and former long-term users of anabolic\u2013androgenic steroids"],"prefix":"10.1093","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2085-3487","authenticated-orcid":false,"given":"Rang","family":"Abdullah","sequence":"first","affiliation":[{"name":"Institute of Clinical Medicine, University of Oslo , Oslo , Norway"},{"name":"Anabolic Androgenic Steroid Research Group, Section for Clinical Addiction Research, Division of Mental Health and Addiction, Oslo University Hospital , Oslo , Norway"},{"name":"ProCardio Center for Research-Based Innovation, Department of Cardiology, Rikshospitalet, Oslo University Hospital , Sognsvannsveien 20, 0372 Oslo , Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2353-8455","authenticated-orcid":false,"given":"Astrid","family":"Bj\u00f8rnebekk","sequence":"additional","affiliation":[{"name":"Anabolic Androgenic Steroid Research Group, Section for Clinical Addiction Research, Division of Mental Health and Addiction, Oslo University Hospital , Oslo , Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9697-6790","authenticated-orcid":false,"given":"Lisa E","family":"Hauger","sequence":"additional","affiliation":[{"name":"Anabolic Androgenic Steroid Research Group, Section for Clinical Addiction Research, Division of Mental Health and Addiction, Oslo University Hospital , Oslo , Norway"},{"name":"National Centre for Epilepsy, Section for Clinical Psychology and Neuropsychology, Oslo University Hospital , Oslo , Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1115-0085","authenticated-orcid":false,"given":"Ingunn R","family":"Hullstein","sequence":"additional","affiliation":[{"name":"Norwegian Doping Control Laboratory, Department of Pharmacology, Oslo University Hospital , Oslo , Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3800-765X","authenticated-orcid":false,"given":"Thor","family":"Edvardsen","sequence":"additional","affiliation":[{"name":"Institute of Clinical Medicine, University of Oslo , Oslo , Norway"},{"name":"ProCardio Center for Research-Based Innovation, Department of Cardiology, Rikshospitalet, Oslo University Hospital , Sognsvannsveien 20, 0372 Oslo , Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4900-0453","authenticated-orcid":false,"given":"Kristina H","family":"Haugaa","sequence":"additional","affiliation":[{"name":"Institute of Clinical Medicine, University of Oslo , Oslo , Norway"},{"name":"ProCardio Center for Research-Based Innovation, Department of Cardiology, Rikshospitalet, Oslo University Hospital , Sognsvannsveien 20, 0372 Oslo , Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2568-3867","authenticated-orcid":false,"given":"Vibeke M","family":"Almaas","sequence":"additional","affiliation":[{"name":"ProCardio Center for Research-Based Innovation, Department of Cardiology, Rikshospitalet, Oslo University Hospital , Sognsvannsveien 20, 0372 Oslo , Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,11,22]]},"reference":[{"key":"2024032723420319400_zwad362-B1","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/j.drugpo.2018.02.022","article-title":"Identifying a typology of men who use anabolic androgenic steroids (AAS)","volume":"55","author":"Zahnow","year":"2018","journal-title":"Int J Drug Policy"},{"key":"2024032723420319400_zwad362-B2","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1016\/j.mce.2017.02.039","article-title":"History and epidemiology of anabolic androgens in athletes and non-athletes","volume":"464","author":"Kanayama","year":"2018","journal-title":"Mol Cell Endocrinol"},{"key":"2024032723420319400_zwad362-B3","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1016\/j.annepidem.2014.01.009","article-title":"The global epidemiology of anabolic-androgenic steroid use: a meta-analysis and meta-regression analysis","volume":"24","author":"Sagoe","year":"2014","journal-title":"Ann Epidemiol"},{"key":"2024032723420319400_zwad362-B4","doi-asserted-by":"crossref","first-page":"893","DOI":"10.1016\/j.amjcard.2010.05.013","article-title":"Cardiac and metabolic effects of anabolic-androgenic steroid abuse on lipids, blood pressure, left ventricular dimensions, and rhythm","volume":"106","author":"Achar","year":"2010","journal-title":"Am J Cardiol"},{"key":"2024032723420319400_zwad362-B5","doi-asserted-by":"crossref","first-page":"146","DOI":"10.2174\/1570159X13666141210225414","article-title":"Anabolic androgenic steroid (AAS) related deaths: autoptic, histopathological and toxicological findings","volume":"13","author":"Frati","year":"2015","journal-title":"Curr Neuropharmacol"},{"key":"2024032723420319400_zwad362-B6","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1080\/20961790.2019.1595350","article-title":"Sudden cardiac death in anabolic androgenic steroids abuse: case report and literature review","volume":"4","author":"Hern\u00e1ndez-Guerra","year":"2019","journal-title":"Forensic Sci Res"},{"key":"2024032723420319400_zwad362-B7","doi-asserted-by":"crossref","first-page":"e13","DOI":"10.1016\/j.forsciint.2011.10.032","article-title":"Anabolic androgenic steroids abuse and cardiac death in athletes: morphological and toxicological findings in four fatal cases","volume":"217","author":"Montisci","year":"2012","journal-title":"Forensic Sci Int"},{"key":"2024032723420319400_zwad362-B8","doi-asserted-by":"crossref","first-page":"1991","DOI":"10.1161\/CIRCULATIONAHA.116.026945","article-title":"Cardiovascular toxicity of illicit anabolic-androgenic steroid use","volume":"135","author":"Baggish","year":"2017","journal-title":"Circulation"},{"key":"2024032723420319400_zwad362-B9","doi-asserted-by":"crossref","first-page":"1170","DOI":"10.1111\/sms.14172","article-title":"Cardiovascular phenotype of long-term anabolic-androgenic steroid abusers compared with strength-trained athletes","volume":"32","author":"Fyksen","year":"2022","journal-title":"Scand J Med Sci Sports"},{"key":"2024032723420319400_zwad362-B10","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/j.ahj.2018.06.010","article-title":"Cardiac systolic dysfunction in past illicit users of anabolic androgenic steroids","volume":"203","author":"Rasmussen","year":"2018","journal-title":"Am Heart J"},{"key":"2024032723420319400_zwad362-B11","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1177\/0091450920919456","article-title":"Motives and correlates of anabolic-androgenic steroid use with stimulant polypharmacy","volume":"47","author":"Zahnow","year":"2020","journal-title":"Contemp Drug Probl"},{"key":"2024032723420319400_zwad362-B12","doi-asserted-by":"crossref","first-page":"1739","DOI":"10.1161\/ATVBAHA.119.312461","article-title":"Methamphetamine use and cardiovascular disease","volume":"39","author":"Kevil","year":"2019","journal-title":"Arterioscler Thromb Vasc Biol"},{"key":"2024032723420319400_zwad362-B13","doi-asserted-by":"publisher","DOI":"10.3390\/ijms20030584","article-title":"Acute and chronic effects of cocaine on cardiovascular health","volume":"20","author":"Kim","year":"2019","journal-title":"Int J Mol Sci"},{"key":"2024032723420319400_zwad362-B14","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1111\/add.14713","article-title":"Psychostimulant use disorder and the heart","volume":"115","author":"Duflou","year":"2020","journal-title":"Addiction"},{"key":"2024032723420319400_zwad362-B15","doi-asserted-by":"crossref","first-page":"3021","DOI":"10.1093\/eurheartj\/ehy339","article-title":"2018 ESC\/ESH guidelines for the management of arterial hypertension","volume":"39","author":"Williams","year":"2018","journal-title":"Eur Heart J"},{"key":"2024032723420319400_zwad362-B16","doi-asserted-by":"crossref","first-page":"9707","DOI":"10.1038\/s41598-022-14065-5","article-title":"Reduced arterial elasticity after anabolic-androgenic steroid use in young adult males and mice","volume":"12","author":"Melsom","year":"2022","journal-title":"Sci Rep"},{"key":"2024032723420319400_zwad362-B17","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1097\/HJH.0000000000001546","article-title":"Increased blood pressure and aortic stiffness among abusers of anabolic androgenic steroids: potential effect of suppressed natriuretic peptides in plasma?","volume":"36","author":"Rasmussen","year":"2018","journal-title":"J Hypertens"},{"key":"2024032723420319400_zwad362-B18","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1093\/eurjpc\/zwab198","article-title":"Cardiovascular effects of doping substances, commonly prescribed medications and ergogenic aids in relation to sports: a position statement of the sport cardiology and exercise nucleus of the European Association of Preventive Cardiology","volume":"29","author":"Adami","year":"2022","journal-title":"Eur J Prev Cardiol"},{"key":"2024032723420319400_zwad362-B19","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1159\/000526418","article-title":"Use of high-dose androgens is associated with reduced brain derived neurotrophic factor in male weightlifters","volume":"113","author":"Bjornebekk","year":"2023","journal-title":"Neuroendocrinology"},{"key":"2024032723420319400_zwad362-B20","first-page":"579","article-title":"Long-term anabolic\u2013androgenic steroid use is associated with deviant brain aging","volume":"6","author":"Bj\u00f8rnebekk","year":"2021","journal-title":"Biol Psychiatry Cogn Neurosci Neuroimaging"},{"key":"2024032723420319400_zwad362-B21","doi-asserted-by":"crossref","first-page":"1405","DOI":"10.1111\/add.14629","article-title":"Structural brain characteristics of anabolic-androgenic steroid dependence in men","volume":"114","author":"Hauger","year":"2019","journal-title":"Addiction"},{"key":"2024032723420319400_zwad362-B22","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1002\/dta.1900","article-title":"Black market products confiscated in Norway 2011\u20132014 compared to analytical findings in urine samples","volume":"7","author":"Hullstein","year":"2015","journal-title":"Drug Test Anal"},{"key":"2024032723420319400_zwad362-B23","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1016\/j.biopsych.2016.06.017","article-title":"Structural brain imaging of long-term anabolic-androgenic steroid users and nonusing weightlifters","volume":"82","author":"Bj\u00f8rnebekk","year":"2017","journal-title":"Biol Psychiatry"},{"key":"2024032723420319400_zwad362-B24","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1037\/neu0000537","article-title":"Cognitive performance and structural brain correlates in long-term anabolic-androgenic steroid exposed and nonexposed weightlifters","volume":"33","author":"Bj\u00f8rnebekk","year":"2019","journal-title":"Neuropsychology"},{"key":"2024032723420319400_zwad362-B25","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1159\/000526418","article-title":"Use of high-dose androgens is associated with reduced brain-derived neurotrophic factor in male weightlifters","volume":"113","author":"Bj\u00f8rnebekk","year":"2023","journal-title":"Neuroendocrinology"},{"key":"2024032723420319400_zwad362-B26"},{"key":"2024032723420319400_zwad362-B27","first-page":"1086","article-title":"American society of Echocardiography recommendations for use of echocardiography in clinical trials","volume":"17","author":"Gottdiener","year":"2004","journal-title":"J Am Soc Echocardiogr"},{"key":"2024032723420319400_zwad362-B28","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1016\/0002-9149(86)90771-X","article-title":"Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings","volume":"57","author":"Devereux","year":"1986","journal-title":"Am J Cardiol"},{"key":"2024032723420319400_zwad362-B29","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/j.echo.2016.01.011","article-title":"Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging","volume":"29","author":"Nagueh","year":"2016","journal-title":"J Am Soc Echocardiogr"},{"key":"2024032723420319400_zwad362-B30","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1161\/01.CIR.101.3.336","article-title":"The athlete\u2019s heart","volume":"101","author":"Pluim","year":"2000","journal-title":"Circulation"},{"key":"2024032723420319400_zwad362-B31","doi-asserted-by":"crossref","first-page":"1949","DOI":"10.1093\/eurheartj\/ehx532","article-title":"European Association of Preventive Cardiology (EAPC) and European Association of Cardiovascular Imaging (EACVI) joint position statement: recommendations for the indication and interpretation of cardiovascular imaging in the evaluation of the athlete\u2019s heart","volume":"39","author":"Pelliccia","year":"2018","journal-title":"Eur Heart J"},{"key":"2024032723420319400_zwad362-B32","doi-asserted-by":"crossref","first-page":"678","DOI":"10.1016\/j.jchf.2018.03.006","article-title":"Temporal trends in the incidence of and mortality associated with heart failure with preserved and reduced ejection fraction","volume":"6","author":"Tsao","year":"2018","journal-title":"JACC Heart Fail"},{"key":"2024032723420319400_zwad362-B33","doi-asserted-by":"crossref","first-page":"1928","DOI":"10.1093\/eurjpc\/zwab086","article-title":"Biventricular dysfunction and lung congestion in athletes on anabolic androgenic steroids: a speckle tracking and stress lung echocardiography analysis","volume":"28","author":"D'Andrea","year":"2022","journal-title":"Eur J Prev Cardiol"},{"key":"2024032723420319400_zwad362-B34","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.echo.2014.10.003","article-title":"Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging","volume":"28","author":"Lang","year":"2015","journal-title":"J Am Soc Echocardiogr"},{"key":"2024032723420319400_zwad362-B35","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1016\/j.jacc.2016.11.041","article-title":"Isolated subepicardial right ventricular outflow tract scar in athletes with ventricular tachycardia","volume":"69","author":"Venlet","year":"2017","journal-title":"J Am Coll Cardiol"},{"key":"2024032723420319400_zwad362-B36","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1016\/j.jcmg.2020.07.039","article-title":"Cardiac phenotypes and markers of adverse outcome in elite athletes with ventricular arrhythmias","volume":"14","author":"Lie","year":"2021","journal-title":"JACC Cardiovasc Imaging"},{"key":"2024032723420319400_zwad362-B37","doi-asserted-by":"crossref","first-page":"732318","DOI":"10.3389\/frph.2021.732318","article-title":"Anabolic androgenic steroids induce reversible left ventricular hypertrophy and cardiac dysfunction, echocardiography results of the HAARLEM study","volume":"3","author":"Smit","year":"2021","journal-title":"Front Reprod Health"},{"key":"2024032723420319400_zwad362-B38","doi-asserted-by":"crossref","first-page":"2343","DOI":"10.1001\/jama.292.19.2343","article-title":"Regression of electrocardiographic left ventricular hypertrophy during antihypertensive treatment and the prediction of major cardiovascular events","volume":"292","author":"Okin","year":"2004","journal-title":"JAMA"}],"container-title":["European Journal of Preventive Cardiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/eurjpc\/advance-article-pdf\/doi\/10.1093\/eurjpc\/zwad362\/54538662\/zwad362.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eurjpc\/article-pdf\/31\/5\/599\/57104494\/zwad362.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eurjpc\/article-pdf\/31\/5\/599\/57104494\/zwad362.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,3,27]],"date-time":"2024-03-27T19:43:01Z","timestamp":1711568581000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/eurjpc\/article\/31\/5\/599\/7441956"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,22]]},"references-count":38,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2023,11,22]]},"published-print":{"date-parts":[[2024,3,27]]}},"URL":"https:\/\/doi.org\/10.1093\/eurjpc\/zwad362","relation":{"has-preprint":[{"id-type":"doi","id":"10.1101\/2023.09.06.23295123","asserted-by":"object"}]},"ISSN":["2047-4873","2047-4881"],"issn-type":[{"value":"2047-4873","type":"print"},{"value":"2047-4881","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2024,3]]},"published":{"date-parts":[[2023,11,22]]}}}