Anabolic–Androgenic Steroids and Myocardial Injury in Bodybuilders: A Narrative Review
DOI:
https://doi.org/10.12775/QS.2026.76.75417Keywords
anabolic–androgenic steroids, bodybuilding, coronary microvascular dysfunction, myocardial infarction with non-obstructive coronary arteries, sports cardiologyAbstract
Background. Non-medical anabolic–androgenic steroid (AAS) use is associated with several cardiovascular pathologies including dyslipidaemia, hypertension, erythrocytosis, endothelial dysfunction, thrombosis, vasospasm, and adverse cardiac remodelling. Often it is seen in bodybuilders, where abuse of AAS is prevelant. One of the life threatning consequence is myocardial infarction including myocardial infarction with non-obstructive coronary arteries (MINOCA).
Aim. To review the relationship between AAS exposure, MINOCA, and coronary microvascular dysfunction (CMD) in bodybuilders.
Material and methods. A targeted narrative search of PubMed/MEDLINE identified peer-reviewed studies including reviews, consensus documents and case reports concerning AAS, cardiovascular injury, MINOCA, and CMD.
Results. AAS may induce atherogenic, thrombotic, haemodynamic, vascular, and myocardial adverse effects. In athletes, MINOCA might clinically present itself as occult plaque disruption, transient thrombosis, epicardial or microvascular spasm, CMD, or oxygen supply–demand mismatch during severe hypertension and exertion.
Conclusions. AAS exposure should always be considered in young strength athletes with acute coronary syndrome. MINOCA requires mechanism-oriented investigation using non-invasive imaging, intracoronary imaging, coronary physiology, and vasoreactivity testing as appropriate. Current evidence supports biological plausibility but does not prove that AAS directly causes CMD.
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