Anabolic Steroids: Stroke Risk And Devastating Effects

how can anabolic steroids cause strokes

Anabolic steroids are synthetic derivatives of the male hormone testosterone. They are commonly abused by athletes and bodybuilders to enhance physical appearance and performance. The abuse of anabolic steroids has been associated with various adverse health effects, including an increased risk of ischemic stroke. Ischemic stroke occurs when a blood clot blocks or plugs a blood vessel in the brain, and anabolic steroids can promote this by increasing vascular tone, arterial tension, and platelet aggregation. This can lead to atherothrombotic events, resulting in stroke. Additionally, anabolic steroids can negatively affect cholesterol levels, with a particular increase in low-density lipoprotein (LDL) and a decrease in high-density lipoprotein (HDL). This alteration in cholesterol levels further elevates the risk of ischemic stroke. Given the potential for serious health complications, it is crucial for clinicians to consider anabolic steroid abuse as a possible cause of ischemic stroke, especially in younger patients.

Characteristics Values
Anabolic steroids abuse Anabolic androgenic steroid (AAS) abuse
Adverse effects Secretion suppression of gonadotropins, neuropsychiatric effects, dyslipidemia, hypertension, arrhythmia, erythrocytosis, decreased arterial plasticity, acne, balding, cardiovascular and cerebrovascular disease, myocardial injury, polycythemia, ischemic events, and more
Risk factors Age, hypertension, obesity, hyperglycemia, hyperlipidemia, diabetes mellitus, renal dysfunction, smoking, physical inactivity, diet, migraine, hormonal contraceptives, pregnancy, cervical arterial dissection, vasculitis, haematological diseases, substance abuse
Mechanism of stroke Atherogenic effects, thrombotic/haemostatic and vasospastic effects, direct myocardial injury, hypercoagulability, increased vascular tone and arterial tension, platelet aggregation, enhanced thrombus formation

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Anabolic steroids can increase vascular tone, arterial tension, and platelet aggregation

Anabolic steroids have been linked to a range of adverse medical and psychological consequences, including cardiovascular complications. Studies have shown that the administration of high doses of anabolic steroids can lead to structural alterations of blood vessel walls, causing endothelial dysfunction. This can affect the elastic properties of the vasculature, reducing arterial elasticity and increasing arterial stiffness. Loss of elasticity in the larger central arteries contributes to the development of heart disease related to systolic hypertension.

In addition, anabolic steroids can cause atherogenic effects, increasing the risk of an ischemic event by raising LDL (low-density lipoprotein) cholesterol and lowering HDL (high-density lipoprotein) cholesterol. This may lead to the oxidation of excess LDL-C at the arterial endothelium, impairing endothelium-dependent arterial relaxation by inhibiting nitric oxide production, and predisposing the patient to vasospasm.

The abuse of anabolic steroids has also been associated with increased platelet aggregation, which plays a pathogenic role in myocardial infarction and stroke. This may be due to the effect of anabolic steroids on the hemostatic system, which can result in a prothrombotic state with abnormally high thrombin-antithrombin complexes in the plasma and higher concentrations of plasma fibrinogen, plasminogen, and plasmin inhibitor. This can further increase the risk of thrombus formation and ischemic stroke.

In summary, anabolic steroids can increase vascular tone, arterial tension, and platelet aggregation through their impact on the vasculature, lipid profile, and hemostasis. These effects can lead to atherothrombosis or embolization in the carotids or the heart, increasing the risk of ischemic stroke.

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They can cause atherothrombotic phenomena

Anabolic steroids can cause atherothrombotic phenomena, which is the formation of a blood clot within an artery as a result of atherosclerosis. Atherosclerosis is a diffuse process that usually develops over many years, even decades, and can start as early as childhood. It progresses asymptomatically through adulthood and is clinically manifested later in life as coronary artery disease, stroke, transient ischemic attack, and peripheral arterial disease. Atherothrombosis is a progressive disease characterised by the accumulation of lipids, fibrous material, and minerals in the arterial wall, leading to a narrowing of the arterial lumen.

The use of anabolic steroids can increase the risk of atherothrombosis by affecting cholesterol metabolism. Specifically, steroid abuse may cause an increase in low-density lipoprotein cholesterol (LDL) and a decrease in high-density lipoprotein cholesterol (HDL) by up to 20%. This is due to the ability of steroids to increase the activity of hepatic triglyceride lipase, which regulates serum lipids and lipoproteins. The resulting lipid changes decrease the regression of atherosclerotic plaques. Steroids have also been linked to reduced apolipoprotein A1 levels, which is associated with the development of atherosclerosis of the arterial wall.

In addition, anabolic steroids can increase vascular tone and arterial tension, further promoting atherothrombotic phenomena. The overall risk of arterial disease is increased by three to six times and can occur within 9 weeks of steroid administration. This alteration in cholesterol metabolism, along with the effects on vascular tone and arterial tension, contributes to the development of atherothrombosis and the associated risk of stroke.

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They can increase homocysteine levels, which is linked to an increased risk of ischaemic stroke

Anabolic steroids can increase homocysteine levels, which is linked to an increased risk of ischaemic stroke. Homocysteine is a by-product of methionine metabolism, and even mildly elevated levels of this amino acid are associated with venous thrombosis and endothelial dysfunction. Several studies have established that the association between plasma homocysteine concentration and the risk of cardiovascular disease or severity of atherosclerosis is graded throughout the normal range from mild to elevated concentrations.

Graham et al. demonstrated that long-term use of anabolic steroids elevates serum homocysteine levels, which leads to an increased risk of ischaemic stroke. This is supported by a study by Ebenbichler et al., which found that bodybuilders in the "build-up" phase of their training cycle who were taking anabolic steroids had significantly higher homocysteine levels than those in other phases or control athletes.

In a case study, a 25-year-old male presented with acute right middle cerebral artery infarct and was found to have elevated homocysteine levels as well as anabolic steroid use. Review of the literature showed that there were seven cases of ischaemic stroke and one case of hemorrhagic stroke reported to be related to anabolic steroid use.

The mechanism by which elevated homocysteine levels increase the risk of ischaemic stroke may be through endothelial cell injury, increased platelet adhesiveness, enhanced oxidation of LDL in the arterial cell wall, or direct activation of the coagulation cascade.

In summary, anabolic steroids can increase homocysteine levels, which is a risk factor for ischaemic stroke. This may be due to the direct effects of anabolic steroids on homocysteine metabolism or indirect effects through their anabolic/catabolic properties.

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They can negatively affect plasma and hepatic HDL levels

Anabolic steroids can negatively affect plasma and hepatic HDL levels, which can lead to an increased risk of stroke. HDL (high-density lipoprotein) is often referred to as "good cholesterol" because it helps to remove other forms of cholesterol from the bloodstream, reducing the risk of clogged arteries. Anabolic steroids can decrease HDL levels by up to 20%, leading to a build-up of cholesterol in the body. This build-up can result in atherosclerosis, which is the narrowing of arteries due to plaque formation. Atherosclerosis increases the risk of blood clots, which can lead to stroke if a clot travels to the brain and blocks blood flow.

In addition to the direct impact on HDL levels, anabolic steroids can also increase LDL (low-density lipoprotein) levels by up to 20%. LDL is considered "bad cholesterol" as high levels can lead to a build-up of plaque in the arteries, further increasing the risk of blood clots and stroke. The combination of decreased HDL and increased LDL levels caused by anabolic steroid use creates a pro-atherogenic environment in the body, making it more susceptible to the development of clogged and narrowed arteries.

The effects of anabolic steroids on HDL and LDL levels are primarily due to their impact on apolipoprotein A-I and B synthesis. Apolipoproteins are proteins that combine with lipids to form lipoproteins, such as HDL and LDL. By modifying the synthesis of these apolipoproteins, anabolic steroids alter the levels of HDL and LDL in the body, leading to a disruption in the normal balance of cholesterol metabolism.

Furthermore, anabolic steroids can also increase vascular tone and arterial tension. This can promote atherothrombotic phenomena, which is the formation of blood clots within narrowed arteries. The increased vascular tone and arterial tension, along with the altered cholesterol levels, contribute to a higher risk of blood clots and, subsequently, an increased risk of stroke.

The negative impact of anabolic steroids on plasma and hepatic HDL levels is a significant factor in the potential for stroke development. The decrease in HDL and the associated increase in LDL can lead to atherosclerosis and promote atherothrombotic events. These changes in cholesterol metabolism, combined with the effects on vascular tone and arterial tension, create an environment in the body that is more susceptible to blood clots, which can ultimately lead to stroke if a clot travels to the brain.

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They can cause myocardial injury

Anabolic steroids can cause myocardial injury in several ways.

Firstly, they can cause an increase in myocardial thickness due to an increase in matrix collagen deposition and fibrosis, which can lead to disturbances in coordinated contraction and subsequent pump failure. This can result in a reduced ejection fraction, which is a measure of how much blood the heart can pump out.

Secondly, anabolic steroids can cause direct myocardial cell injury, leading to cell death and scar formation, which can predispose individuals to arrhythmias.

Thirdly, anabolic steroids can affect the Renin-Angiotensin-Aldosterone System (RAAS), which can cause left ventricular hypertrophy and cardiac fibrosis through elevated blood pressure, the direct action of angiotensin II on cardiac myocytes, and aldosterone-mediated effects.

Finally, anabolic steroids can increase the risk of thrombosis by enhancing platelet aggregation and thrombus formation, which can lead to myocardial infarction and stroke.

The combination of these factors can contribute to increased morbidity and mortality from myocardial infarction and stroke in individuals who use anabolic steroids.

Frequently asked questions

Anabolic steroids are synthetic derivatives of the male hormone testosterone. They are used to enhance athletic performance, physical appearance, and sexual function.

Anabolic steroids can cause strokes by increasing vascular tone, arterial tension, and platelet aggregation, leading to atherothrombotic phenomena. They can also cause a decrease in HDL cholesterol and an increase in LDL cholesterol, which can lead to atherosclerosis.

Signs and symptoms of a stroke caused by anabolic steroids can include slurred speech, weakness or numbness on one side of the body, visual loss, and confusion.

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