Anabolic steroid abuse and cardiac sudden death: a pathologic study.

Arch Pathol Lab Med. 2001 Feb;125(2):253-5.

Anabolic steroid abuse and cardiac sudden death: a pathologic study.

Fineschi V, Baroldi G, Monciotti F, Paglicci Reattelli L, Turillazzi E.

CONTEXT: Androgenic anabolic steroids (AAS) used for improving physical
performance have been considered responsible for acute myocardial infarction and
sudden cardiac death.

OBJECTIVE: To establish the relationship between AAS and
cardiac death.

DESIGN: Case report.

PATIENTS: Two young, healthy, male
bodybuilders using AAS.

MAIN OUTCOME MEASURES: Pathologic cardiac findings
associated with AAS ingestion.

RESULTS: The autopsy revealed normal coronary
arteries. In one case, we documented a typical infarct with a histologic age of 2
weeks. A segmentation of myocardial cells at the intercalated disc level was
observed in the noninfarcted region. This segmentation was the only anomaly
detected in the second case. No other pathologic findings in the heart or other
organs were found. Urine in both subjects contained the metabolites of
nortestosterone and stanozolol.

COMMENT: A myocardial infarct without vascular
lesions is rare. To our knowledge, its association with AAS use, bodybuilding, or
both lacks any evidence of a cause-effect relationship. The histologic findings
in our 2 cases and in the few others reported in medical literature are
nonspecific and do not prove the cardiac toxicity of AAS. A better understanding
of AAS action on the neurogenic control of the cardiac function in relation to
regional myocardial contraction and vascular regulation is required.