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The purpose of this study was to investigate the effect of anabolic steroid (AS) use on cardiac structure and function and cardiovascular risk factors.We recruited 47 strength-trained individuals (male = 46, female = 1), with 28 self-reporting regular AS use and 19 self-reporting never taking AS. Participants underwent assessment of body composition, lipid profiles, blood pressure, 12-lead ECG, and a comprehensive echocardiographic examination incorporating speckle tracking of longitudinal, radial, and circumferential left ventricular (LV) motion. A subgroup of AS users (n = 4) were tested during periods of AS use and abstinence.AS users were heavier (96 ± 15 vs 81 ± 9 kg, P < 0.05), had higher LDL (3.68 ± 0.47 vs 2.41 ± 0.49 mmol·L−1, P < 0.05), and had higher resting HR (79 ± 12 vs 64 ± 13 beats·min−1), although blood pressures did not differ significantly between groups. In AS, LV wall thickness and mass were significantly greater (12 ± 2 vs 11 ± 1 mm and 280 ± 60 vs 231 ± 44 g, respectively, P < 0.05), whereas ejection fractions and peak longitudinal strain ([Latin Small Letter Open E]) were significantly lower (58% ± 8% vs 63% ± 6% and −14.6% ± 2.3% vs −16.9% ± 2.2%, P < 0.05). Indices of global diastolic function were reduced in AS users (E/A, E′/A′). Some diastolic strain rates (ESR and ASR) were altered in AS users. The E/A SR ratio was reduced in the longitudinal plane as well as in the circumferential and radial plane at the basal level (P < 0.05). Basal LV E/A rotation rate was also decreased in AS users (P < 0.05).AS use is associated with alterations in cardiac structure and function that, allied to poor lipid profiles, represent an increased cardiovascular risk profile.