Steroid Use: Stroke Risk And Complications

Anabolic androgenic steroid (AAS) abuse is becoming increasingly common among athletes, casual fitness enthusiasts, and amateur athletes. AAS are synthetic derivatives of testosterone and have been linked to a range of adverse health effects, including an increased risk of cerebrovascular disease and stroke. While the exact mechanisms are still being studied, AAS are believed to cause stroke by increasing hypercoagulability, enhancing platelet aggregation and thrombus formation, and causing vasospasm and thrombotic/haemostatic effects. Given the potential risks associated with AAS abuse, it is important for healthcare professionals to screen for this unusual risk factor, especially in young patients experiencing stroke.

Anabolic steroid abuse can increase hypercoagulopathy

Anabolic steroid abuse can have several adverse health effects, including an increased risk of cerebrovascular disease and stroke. This is primarily due to the steroids' impact on the body's coagulation process, leading to a hypercoagulable state.

Hypercoagulability refers to an increased tendency for the blood to form clots. When an individual abuses anabolic steroids, it can induce a hypercoagulable state by increasing platelet production of thromboxane A2, decreasing the production of prostacyclin, and increasing fibrinogen levels. This results in enhanced platelet aggregation and thrombus formation, making it easier for blood clots to form.

Additionally, anabolic steroids can act directly and indirectly by stimulating erythropoietin, which increases haematopoiesis. This leads to significantly increased levels of haemoglobin and haematocrit when used in supraphysiological doses. Elevated haematocrit levels are an independent risk factor for stroke and can interact synergistically with elevated blood pressure to further increase the likelihood of a stroke occurring.

Furthermore, anabolic steroid abuse has been linked to increased levels of clotting factors and plasminogen, which can also induce a hypercoagulable state. Prolonged use of anabolic steroids can also elevate serum homocysteine levels, which is another risk factor for ischaemic stroke.

The abuse of anabolic steroids has been associated with an increased risk of cerebrovascular disease and stroke, particularly in younger individuals. This is a growing public health concern, as the non-medical use of anabolic steroids is on the rise, especially among casual fitness enthusiasts and amateur athletes. Therefore, it is crucial for physicians and healthcare professionals to be aware of the potential adverse effects of anabolic steroid abuse and to consider anabolic steroid misuse as a risk factor for cerebrovascular disease and stroke, even in younger patients.

AAS use can cause peripheral vascular tone and cardiac hypertrophy

Anabolic androgenic steroids (AAS) are known to have toxic effects on the cardiovascular system. AAS can increase peripheral vascular tone and cardiac hypertrophy, which can lead to an increased risk of cardiovascular diseases such as coronary atherosclerosis, hypertension, myocardial necrosis, cardiac hypertrophy, thromboembolism, and arrhythmia.

AAS abuse has been linked to an increased risk of atherosclerosis, which is a disease characterised by the narrowing of arteries due to plaque formation. This is primarily caused by a lipid metabolism disorder, which leads to decreased high-density lipoprotein (HDL) and increased low-density lipoprotein (LDL) levels. AAS use can also directly affect the coagulation and fibrinolysis system, increasing the risk of arterial and intra-cardiac embolism, deep vein thrombosis, and pulmonary embolism.

AAS abuse is associated with higher blood pressure and can cause a persistent elevation in blood pressure for up to 12 months after discontinuation. This may be due to water-sodium retention in the kidneys, resulting in increased blood volume and blood pressure. AAS abuse can also lead to coronary spasm, which can cause atherosclerotic plaques to detach and form thrombosis, obstructing coronary artery lumens and resulting in ischemic myocardial necrosis.

AAS has also been linked to myocardial apoptosis and cardiac hypertrophy. Studies have shown that AAS can induce significant myocardial apoptosis in a dose-dependent manner, with similar apoptosis observed in myocardial cells after norethandrolone therapy. AAS abuse can also lead to abnormal electrical activity in the heart, with ECGs often showing irregular electrical activity during physical exertion.

In summary, AAS abuse can cause an increase in peripheral vascular tone and cardiac hypertrophy, leading to a range of cardiovascular diseases. The toxic effects of AAS on the cardiovascular system highlight the importance of awareness and caution when using these substances.

Adverse effects of AAS usage include secretion suppression of gonadotropins

AASs are synthetic derivatives of testosterone and can be divided broadly into two categories: aromatizable and non-aromatizable androgens. Aromatizable AAS like nandrolone are direct derivatives of testosterone and a substrate for aromatase, which removes the methyl group from the 19th position of the androgen ring. Non-aromatizable AAS such as winstrol or trenbolone are modified such that the 19th carbon is not recognized as a substrate by aromatase, and therefore, they are not converted to estrogen.

Administration of AASs can be oral or parenteral. The majority of athletes use intramuscular AASs in supraphysiologic doses equivalent to at least 1000 mg of testosterone per week. Many athletes administer AASs in 2–3 cycles per year, with each cycle generally lasting 6–18 weeks, the recovery periods between the cycles are meant to allow the recovery of the hypothalamic-pituitary-gonadal (HPG) axis. In a typical cycle, 2–3 different AASs are stacked together to maximize their impact.

AASs have been associated with a variety of adverse effects that impact many organ systems. These adverse effects include neuropsychiatric and behavioral, gonadal, hepatic, dermatological, musculoskeletal, and renal effects.

AAS abuse is used for enhancement of athletic performance, physical appearance, and sexual function

Anabolic-androgenic steroids (AAS) are used by athletes and non-athletes for enhancement in athletic performance, physical appearance, and sexual function. AAS are testosterone derivatives that increase muscle mass and strength. The abuse of AAS is a prevalent problem in competitive and non-competitive athletes, with studies showing a continuing and significant increase in use among adolescent athletes and non-athletes.

Athletic Performance

The abuse of AAS is a widespread issue in sports, with many elite athletes having used AAS since the 1950s, and the drugs becoming more common among the general population in the 1980s. AAS abuse is not limited to professional and Olympic athletes, but also extends to adolescent athletes and non-athletes. The stimulatory effects of androgens on the brain, which can result in a feeling of euphoria and increased aggressiveness, have contributed to the widespread use of AAS.

Physical Appearance

The non-medical use of AAS is a growing public health problem, with the global lifetime prevalence rate of AAS use estimated to be as high as 6.4% for men and 1.6% for women. The number of people reporting lifetime use of anabolic steroids in England and Wales increased from 194,000 in 2005/2006 to 271,000 in 2015/2016. AAS use is not only confined to bodybuilders and professional sportsmen but is also increasing among casual fitness enthusiasts, non-competitive bodybuilders, and amateur athletes who wish to improve their physical appearance, body image, or performance.

Sexual Function

AAS administration is often associated with adverse effects that are generally dose-related. High and multi-doses of AAS used for athletic enhancement can lead to serious and irreversible organ damage, including reduced fertility in males and masculinization in women and children. Other adverse effects include hypertension, atherosclerosis, blood clotting, jaundice, hepatic neoplasms, and carcinoma.

AASs have the potential to cause cardiovascular harm and can therefore increase the risk of ischaemic stroke

Anabolic-androgenic steroids (AASs) are synthetic derivatives of testosterone that are used clinically to boost protein synthesis, muscle growth, and erythropoiesis. However, their misuse is associated with a range of adverse health effects, including an increased risk of cardiovascular harm and ischaemic stroke.

AASs can disrupt the body's natural hormone balance, leading to abnormal endogenous hormone secretion and a range of reversible or irreversible damage. One of the most common side effects of AAS misuse is increased secretion of oil from sebaceous glands, which can cause dermatological issues such as acne vulgaris, androgenic alopecia, and hypertrichosis. AAS misuse can also induce sexual problems in both men and women, such as testicular atrophy, impotence, and amenorrhea.

The misuse of AASs is also associated with an increased risk of cardiovascular harm and can, therefore, increase the risk of ischaemic stroke. AASs can affect the cardiovascular system in multiple ways, including:

• Increasing the level of "bad" cholesterol (low-density lipoprotein or LDL) and decreasing the level of "good" cholesterol (high-density lipoprotein or HDL) in the blood, which contributes to a buildup of plaque inside arteries (atherosclerosis) and increases blood pressure.
• Increasing the risk of blood clots forming in blood vessels, which can disrupt blood flow and damage the heart muscle.
• Causing structural changes in the heart, such as decreasing the function of the heart's ventricles and inducing an irregular heartbeat.

In addition to these cardiovascular effects, AAS misuse can also lead to an increased risk of thromboembolism, which occurs when a blood clot breaks free and travels to another part of the body. Thromboembolism can be life-threatening if the clot travels to the heart or brain, leading to a heart attack or stroke.

The toxic effects of AASs on the cardiovascular system are well-documented, and it is important for both medical personnel and the general public to be aware of these risks. AAS misuse can have serious and potentially life-threatening consequences, and seeking professional advice before using these substances is strongly recommended.

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